By Susan Burke March, MS, RDN, LDN, CDE
The Federal Trade Commission (FTC) has in the last decade filed more than 120 cases challenging health claims made for supplements, claims promising weight loss, cancer cure and reducing the risk for Alzheimer’s disease.
When Dr. Oz promoted Green Coffee Bean Extract as a “miracle” weight loss supplement, the pills flew off the shelves. Then, after Oz was hauled before Congress to explain his claim, the manufacturer was fined $9 million for false advertising.
Close to a half-million people purchased Sensa powder, which when sprinkled on food, was touted as a “miracle” appetite suppressor, and the FTC made them return $26 million to consumers.
If weight loss were so easy, then surely more than 75% of Americans would not be overweight or obese. But that doesn’t stop people from buying these products. And when it comes to the dietary supplement industry, it’s “let the buyer beware”.
FDA and DIETARY SUPPLEMENTS
As reported in The Atlantic, unlike drugs, dietary supplements do not need approval for safety or effectiveness before they go to market. When safety issues arise, the FDA can investigate and take steps to remove a product, but to ban a compound in a dietary supplement, it is required to undertake a series of lengthy scientific and legal actions. Under the Dietary Supplement Health and Education Act of 1994, manufacturers themselves are responsible for evaluating the safety of their products before marketing them, which is a little like having the fox guard the henhouse.
According to Forbes.com, nutritional supplements is one of the fastest growing industries globally, producing about $32 billion in revenue in 2012, projected to double to over $60 billion in 2021. They report, “Ten years ago, it was just the muscle heads and the weekend warriors. Now, it’s the full spectrum with men and especially women.”
You might ask, what is a dietary supplement? According to the FDA, a dietary supplement is a product intended for ingestion that contains a “dietary ingredient” intended to add further nutritional value to the diet. A “dietary ingredient” may be one, or any combination, of the following substances:
• a vitamin
• a mineral
• an herb or other botanical
• an amino acid
• a product to increase total dietary intake
• a concentrate, metabolite, constituent, or extract
Recently, the Center for Science in the Public Interest reported that the New York State Attorney General commissioned an independent panel to test popular herbal supplements sold at major chain retailers GNC, Target, Walgreens, and Walmarts throughout the state. DNA testing found that only 21 percent of the herbal products tested contained DNA from the herb promised on the label.
That means that 79 percent either had no DNA from the advertised herb or had DNA evidence of material from filler plants, such as rice, beans or pine and, some cases, contaminants. They tested echinacea, ginseng, ginkgo biloba, St. John’s wort, and other popular store-brand supplements. None of Walmart’s Spring Valley line of Echinacea contained any DNA evidence of the herb. Instead, it contained powdered radish, houseplants and wheat — despite a claim on the label that the product was wheat- and gluten-free. This is very dangerous for people with celiac disease or who are gluten-sensitive, and must avoid all gluten and/or wheat. (Read my article about gluten here.)
My professional organization, the Academy of Nutrition and Dietetics says, “The best nutritional strategy for promoting optimal health and reducing the risk of chronic disease is to wisely choose a wide variety of foods. Additional nutrients from fortified foods and/or supplements can help some people meet their nutritional needs as specified by science-based nutrition standards.”
For example, vegans or people who eliminate all dairy foods from their diets often find it difficult to ingest adequate levels of nutrients such as calcium or vitamin D or B12, and supplements may be a logical alternative, especially if they lack exposure to good-quality sunlight.
Elderly people, even when healthy, often are unable to fully absorb vitamin B-12 from food, and supplements may be advised. People with certain food allergies, such as celiac disease, may need supplements due to gluten intolerance, which often leads to need for iron and calcium supplementation.
HERBAL SUPPLEMENTS HAVE A PLACE … IN HISTORY!
Herbs form the foundation of medical history. For thousands of years, people have identified and used medicines extracted from botanicals including basic aspirin, to penicillin, and morphine and more. Currently, about 76 percent of the world’s population have used or use some type of herbal supplement, most commonly echinacea, flaxseed, ginseng, ginkgo, saw palmetto, St John’s wort, black cohosh, evening primrose, milk thistle and garlic.
Because of herbal’s medicinal effect, it’s important to not take them haphazardly, but to work with an expert and understand any potential interactions with medications and other herbal supplements. Click here for more information about herbals.
DRUG AND NUTRIENT HAZARDS
The FDA says, “Some products encourage consumers to self-treat for a serious disease without benefit of a medical diagnosis or treatment. Products sold as dietary supplements that bear a claim to treat, mitigate, or cure a disease are drugs and are subject to regulation as such.”
The potential for negative interactions between medications and dietary supplements is well known, but typically you’ll not find that information on the label. For example, the herb St. John’s Wort is often taken for depression and anxiety, but negatively interacts with Xanax (a common medication for anxiety), contraceptive drugs, and Warfarin (Coumadin).
Utilize a drug interaction checker to learn more about the medications and supplements you are taking. If you find interactions, review them with your primary care physician. Be very careful about supplements if you’re scheduled for surgery since some herbal supplements can increase bleeding or cause high blood pressure.
Supplementing a single nutrient or substance, such as vitamin E or B vitamins, is not advised unless your physician says you have a deficiency. More is not better, especially when it comes to vitamins and minerals, because some nutrients taken in excess can cause an imbalance in others. Even a water-soluble vitamin like vitamin C, when taken in excess, can cause stomach problems, including chronic diarrhea. Too much selenium can lead to hair loss, gastrointestinal upset, fatigue, and even nerve damage.
On the other hand, you might just be producing expensive urine? Excessive amounts of water-soluble vitamins, like vitamins C and B, are not used by the body and are flushed down the commode.
Although the American Medical Association recommends a multivitamin, other health experts say they’re not essential. But, taking a multi means you’ll consume at least the minimum daily requirement of essential vitamins and minerals without taking in too much of any single one.
And as we age, we metabolize medications differently, and that goes for herbal supplements too. MayoClinic.org recommends you take your herbs with a grain of salt:
• Follow instructions. Don’t exceed recommended dosages or take the herb for longer than recommended.
• Keep track of what you take. Take only one supplement at a time to determine if it’s effective. Make a note of what you take, and how much for how long, and how it affects you.
• Herbal products from some European countries are highly regulated and standardized. But toxic ingredients and prescription drugs have been found in supplements manufactured elsewhere, particularly China, India and Mexico.
• Check alerts and advisories. The FDA maintains lists of supplements that are under regulatory review or that have been reported to cause adverse effects.
EAT YOUR FRUITS AND VEGGIES
The best dietary supplement comes in cute little colorful packages called fruits and vegetables. Only 25% of Americans eat the minimum amount of fresh fruits and vegetables recommended by the USDA daily (5-9 servings, combined). In my next column, I’ll talk about the best places to invest your calories.
SMART SUPPLEMENTS: KNOW THE SOURCE
Even well-known brands have been found to not contain the active ingredients as advertised, and worse, can contain ingredients that can be hazardous to your health. Two third-party independent testing agencies, USP and NSF assure that products bearing their seal contain the ingredients that are listed on the label (and nothing more).