Let’s face it, much of what you see on your news feed is designed to get you to click because then the poster gets paid for that click. And each of us is more likely to “click” if an emotion of some type is triggered. Fear, Anxiety, Anger, Hope, Joy – these are what titles and opening photos are designed to do. Agree with me so far?
My news feed (because the all-knowing-techno-brain-in-the-sky knows my interests) is filled with articles about healthcare, innovation, neuroscience, metabolomics and… supplements. And many of these are pure clickbait sensationalism – BUT, the emotion can’t be triggered unless there is some reasonable problem or solution presented in the title.
There are many reasons supplements are a favorite topic for click-bait articles, and it is because there ARE many problems with nutritional supplements as they are marketed and sold in the US.
Why can I say this reliably? For those of you that don’t know me, I am an MD, trained at Vanderbilt and the Mayo Clinic with Board Certifications in Integrative Medicine, Family Medicine, Neurofeedback, and I am a Certified Nutrition Specialist. I have recommended particular supplements to my patients for over 20 years, and I have been on the inside of the nutritional supplement industry for the last 15 years as a formulator of products, an expert consultant, a quality control evaluator, scientific advisory board member, and I am currently the Medical and Innovation Director for XYMOGEN, the largest and fastest-growing medical-professional-authorized nutritional supplement company in the US. Suffice it to say I have seen both the light side and the dark side of the nutritional supplement industry.
Let’s take a look at some of the real problems with nutritional supplements in the US and why this makes for a good soil from which click-bait articles can grow.
With most supplements you do not know what is REALLY in them, because potency (what is actually in the formula, and PURITY (what is truly NOT in the formula) is rarely disclosed. Terms like “Proprietary Formula” abound to hide the actual quantities. Lack of detail is common to hide the fact that inferior raw materials were used, and the actual manufacturer is hidden from consumer knowledge behind a brand name.
- Of note, in 2015 the New York Attorney General’s office examined the common herb “Devil’s Claw” and found that of the 18 products tested – 2 had no DNA for Devil’s Claw present, and the other 16 for which DNA could be identified, all contained zeyheri [the inferior, less potent variety] rather than procumbens [used in most studies and more potent]. The attorney General’s office issued cease-and-desist letters to several manufacturers due to these quality control issues – several brands you may recognize if you know your supplements: Solaray, The Kroger Co., as parent of Vitacost.com, DaVinci Labs, Thorne Research Inc., Puritan’s Pride, Prescribed Choice, Now Foods, Nature’s Sunshine Products, and Vital Nutrients. Many of these companies market heavily, and promote deep discounts.
- In that same year, the New York Attorney General sent cease-and-desist letters to GNC, Walgreens, Walmart and Target, calling them to stop selling some of their store-brand herbal supplements in New York. They include ginseng, St. John’s Wort, echinacea and ginkgo biloba. It turns out almost 80 percent of the pills officials tested did not contain the key plant ingredient listed on the label, and included fillers like rice and beans, and additional ingredients such as wheat, mustard or radish.
Even if the label is clear – you do not know if the company is ignorant or lying in a way that the label STILL does not match what is in the bottle because many manufacturers do not test beyond the bare minimum for raw-material authenticity, bacterial contamination, toxins, or adulterated materials. And aside from some very basic minimum standards most potency and purity testing is self-monitored by the company itself according to the standards the company sets with little FDA oversight.
Even if you feel sure that the contents of your bottles potent are pure, you are not sure if that pill or potion is really good for you, at this time, in this dose. This is because supplements are generally not patent-protected, so the large investments necessary for large trials are hard to come by because the funders know they will be unable to recoup their research investment dollars. YET, there are many unregulated voices that will tell you their magic pill is good for whatever ails you, and this creates reasonable skepticism and even cynicism.
- Add to this the problem of Amazon where mass competition is driving down supplement profit margins to the extent that smaller companies that are trying to sell their products on this platform have already and will continue to cut corners elsewhere in raw material selection, purity testing, and expiration date games. Amazon’s warehouses may not be air-conditioned, and products may be returned for resale. Not ideal conditions for something that will be brought into the body on a regular basis.
Chemicals (small molecule drugs) have WAY better profit margins than Natural compounds. This has several effects. Beating up on supplements in a blog is not going to anger really big advertisers, while writing an article describing how Omeprazole, better known as the Purple Pill for reflux, increases all-cause death, dementia, pneumonia, and more may have AstraZeneca and Proctor and Gamble’s lawyers after you and fewer large internet venues desiring to pick you up because those companies will not want to advertise on venues where there are articles critical to their products.
- Ironically, Big Pharma and big business owns most supplement companies: Pure Encapsulations, Garden of Life are owned by Nestle, the same company that brings you Nesquik, Tombstone Pizza, Alpo and Carnation Instant Breakfast; Centrum is owned by Pfizer maker of Viagra and Lipitor; Metagenics and Herbalife are owned by Amway, etc.
- While these companies know this strategy diversifies their health care offerings, they are keenly aware that there is not a drug-like profit margin available when one is selling a natural product that takes land, sunshine and, living organisms to produce and after production needs, protection from humidity, heat, light, and radiation to stay in a form usable to the human body.
Often the science is covered up in the headline because emotion makes us click. Describing the nuances of study design, population selection, and clinical and statistical significance, while incredibly important are not sexy.
- Natural compounds are NOT designed to override, block, stimulate or inhibit bodily processes like drugs – so when studied, they often do not show dramatic short-term effects on established disease. But just because an effect takes time does not mean there is no effect.
- Nobody can deny that the quality of our diet in the long-term greatly influences the quality of our health. For this reason, good studies on nutritional compounds need to be appropriately dosed (most are horribly under-dosed) and long enough (years) to show effect that is meaningful. To illustrate this in one well-done study, SAMe given at high dose for two years was able to decrease the need for liver transplant and all-cause mortality in individuals with moderate alcoholic liver disease by nearly 50%! CoQ10 for heart failure was examined in the Q-SYMBIO trial which took place over 2 years and 16 countries using high-dose CoQ10 and it showed a statistically significant improvement in all-cause mortality, hospitalization for heart failure, endurance, and an improvement in heart failure class. It should be part of the standard of care in conventional medicine for certain. Oh, and the placebo had more side effects than the study supplement because the individuals randomized to the supplement were healthier in more ways than just less heart failure.
- Compare these studies with some of the fish-oil drivel that frequents the blogosphere. Most fish oil studies under-dose, do not track blood levels, and are for very short periods of time. Long-term data is clear that those with the highest levels of omega 3 over 15 to 20 yrs have markedly decreased all-cause mortality, but studies expecting to find a drug-like effect are setting the supplement up for failure. It is like comparing a speed-boat and a race-car to a match of speed. The track you choose will make a big difference on who wins. The track supplements need to show off is a long-term measurement of health outcomes, not short-term drag race to decrease symptoms.
- We need more, longer, and better conducted studies that is for certain, and we all need to be able to change our mind given better data on any subject – that goes for advocates for and detractors against the use of nutritional supplements.
A “supplement” can come from a broad range of substances and molecules that are marketed to the public. They can be nutritional agents, minerals, vitamins, plant extracts, or particular food and food concentrates. When recommended by somebody knowledgeable of the product and the person into whom it will go, they are incredibly safe. INCREDIBLY SAFE. But when body-hackers and bio-hackers practicing bro-science are using the term “supplement” to market strong stimulants, illegal hormone-like substances, drug-like high concentrates of mood-altering raw materials, and drug-laced franken-supplements using raw materials coming from China being produced in who-knows-who’s garage, yes, there will be bad outcomes. This is why regulation and transparency are so key in this field. Most all of the negative outcomes attributable to supplements come from the muscle-building gym-rat set of materials. A good example of this is from an article that prompted the writing of this blog. In this article it is warned that many supplements can harm you because they contain higenamine. Honestly, before reading this article, I had never heard of such an ingredient – largely because it is essentially a drug in supplement clothing and I would never consider using it or another of it’s stimulant cousins in a product or recommending those to patients. On a side note, most network marketing companies that launch a line do it with a stimulant and target it towards weight loss and fatigue – because it will work in the short term. It will fail in the long term and may cause other problems like higenamine. But back to higenamine. Look at the product names that contain this ingredient in the quoted study and see if any of them sound like a product to improve fundamental health and well being… “The 24 products tested in the study were: Adrenal Pump, Apidren, Beta-Stim, Burn-HC, Defcon1 Second Strike, Diablo, DyNO, Gnar Pump, Higenamine, High Definition, HyperMax, iBurn2, Liporidex Max, Liporidex PLUS, LipoRUSH DS2, N.O. Vate, OxyShred, Prostun-Advanced Thermogenic, Pyroxamine, Razor8, Ritual, Stim Shot, ThermoVate, and Uplift.” Not only did only 5 of the 24 actually list an exact quantity of this stimulant, those 5 were not correct.
But note the title of the article, “These supplements may actually harm your health.” The article wants clicks so it did not include the name “Higentamine” in the title. If the article wanted to inform, or protect, then it should have read “Higenamine may harm your health,” but then not as many people would click and they would lose ad revenue.
By making the title of the article, “These supplements may actually harm your health,” for those who see the title and do not click and read – they grow in their wariness of all things natural and supplemental – which is a win for big Pharma and big Ag and big HealthCare.
So those are some of the problems that we all know are going on in the background with regard to supplements, and that fuel click-bait like articles.
Our solution in our clinic is to do our best to recommend products for our patients that have been thoroughly vetted from a PURITY and POTENCY standpoint with great documentation, that are manufactured at a facility that produces supplements at or above the standards used for pharmaceuticals, from a company that is family-owned and thereby personally accountable to the end-customer, using doses that are meaningful, of substances that are used in the studies that support their use, for targeted purposes to improve the structure and function of that individual long-term.
One final thought: Supplements are Supplemental. An excellent diet, exercise, adequate restful sleep, stress management, wholesome relationships are the core of health. Nutritional supplements are not manna, they are not the elixir of the gods, they are useful concentrated foods and natural substances that at their best support health in ways that could not be attained without their use. I encourage use with discernment.