The bottom line speaks volumes. Most of the billions we spend on vitamins, herbal remedies and other nutritional supplements is hard-earned cash out of pocket.
There typically is no insurance company to pick up the tab as Americans search for everything from the fountain of youth to fewer hot flashes to more sleep.
And we’re spreading the wealth around. Ten years ago, independent health food stores were about the only places to get serious about supplements. These days you can find cold-and-flu protector echinacea displayed at any downtown pharmacy counter, muscle builder creatine in grocery aisles from Willowbrook to Palatine, weight-loss remedies in health clubs on the North Shore and discount prices offered at competing national chain stores throughout the city and suburbs. The online supply and demand are strong too.
Trouble is, the widespread availability of vitamins, minerals, herbs and other natural substances–those imposing walls and shelves of bottles and boxes–is equally matched by coast-to-coast confusion.
To wit: There is no one category of health practitioners considered expert in the field. The government, by law, is not able to regulate the marketplace beyond outright dangerous products (and then only after the fact). Consumers are left to make their own buying decisions, some better educated guesses than others.
“Which product do you think is the best?” is a question overheard at pretty much any supplement shelf at pretty much any store on pretty much any day. In response, clerks are pretty much making too many choices about our health.
The system is a tangled mess.
“The first thing to realize is it’s not appropriate to treat yourself for serious conditions,” said Charlotte Gyllenhaal, an herbal medicine researcher and associate professor at the University of Illinois at Chicago.
“You need to see a doctor or health practitioner. But finding a knowledgeable practitioner can be difficult. And the fact is, people are treating themselves.”
Experts and consumers alike are increasingly fretting over a set of intertwined questions. One uncertainty builds on the next as people decide on what pills to pop:
Can supplements help me live longer or live better?
If so, what supplements and brands should I take?
Whom can I trust to give me straight answers about supplements?
Answering these questions in turn will help build more awareness about which supplements are best for your quality of life. But remember that there is no one-size-fits-all answer to untangle matters.
Can supplements help me live longer or live better?
A decade ago this question would have been waved off without an answer by most MDs in this country. Not anymore. Most physicians are converts to taking at least a daily multiple vitamin and mineral supplement to prevent such life-shortening illnesses as coronary heart disease, diabetes and cancer.
What’s more, a growing number of physicians are recommending natural remedies for specific conditions.
Expect this comfort level to only increase as more published studies reveal the value of certain supplements.
For example, an estimated 75 percent of the nation’s cardiologists routinely suggest vitamin E supplementation for patients with heart disease risk factors (and half of all heart doctors take it themselves as a preventive measure).
Another case in point is saw palmetto. Dr. Glenn Gerber, a University of Chicago urologist, has been at the leading edge of saw palmetto studies. The herb (from a native American plant, no less) has proved safe and effective for reducing symptoms of benign prostate enlargement.
Colleagues are happy to suggest a remedy that helps patients awaken less often during the night for bathroom trips, especially because the research originates at one of the country’s most respected medical schools.
For her part, Gyllenhaal worries less about consumers who take supplements for preventive reasons or minor conditions, provided no one is taking megadoses. She herself uses fish oil capsules for chronic inflammation in her foot.
“I would rather use the fish oil than anti-inflammatory drugs [which can be hard on the digestive system and bones],” Gyllenhaal said. “It works for me.”
Gyllenhaal is more cautious about taking herbs without professional advice, mostly because as a scientist her life’s work is studying the medicinal effect of plants.
Like many experts, she envisions both the healing power of herbs and the darker side of drug counter-interactions and misguided self-treatment.
Accordingly, think of your prospective supplement use as a multilevel approach. The most basic level would be vitamins and minerals. You are highly unlikely to harm yourself in this category if you avoid large daily doses (“red flag” nutrients include vitamins A and E, plus certain B vitamins and too much iron).
Chances are, you will feel more energetic and likely suffer fewer illnesses with a daily multiple supplement.
The next level of supplement use covers natural substances found in foods and/or the human body, such as amino acids, known as the building blocks of protein.
Although these products are aggressively marketed for muscle-building and even brain power, most researchers contend that taking targeted amino acids works only for highly trained individuals looking for the slight but important competitive edge.
The rest of us mere mortals will do well to save the money and eat high-quality protein in our diets.
On the other hand, fish oil capsules (or flaxseed oil) might prove to be a smart choice for many consumers. The omega-3 fats abundant in fatty fish and flaxseeds are documented to protect against heart disease and certain cancers. Not everyone gets enough omega-3 in their daily diets.
The highest level of supplement-buying decisions includes herbal remedies. Set the bar high when making decisions about herbs. Do some homework. It is always best to seek out professional advice about any herb you contemplate making part of your daily routine. Gyllenhaal said one positive indicator among herbal makers is brands that explain their quality standards on packaging (especially adherence to more advanced European controls) and provide contact information for background research.
What supplements and brands should I take?
Adults will benefit from taking a daily multiple vitamin/mineral supplement. There is debate about whether any brand will do, but sticking to an established company that makes its quality standards available is a healthy bet.
After the multivitamin, the answer depends more on your goals for supplement use. If you are seeking to prevent illness, you would do well to discuss the matter with your doctor, a nutritionist or the growing number of pharmacists who are making it a point to learn about supplements.
Another good strategy is seeking opinions from complementary medicine practitioners such as acupuncturists or chiropractors (lots of savvy consumers feel most comfortable if those practitioners are doing only the recommending and not actually selling the products) who take a holistic approach to wellness. Befriending local health-food-store clerks is not all bad, but don’t be afraid to ask directly about their qualifications for telling you what to take. Some individuals have pursued degrees or professional-level study, others simply have fashioned their opinions from personal experience or company training materials. If they are offended, that tells you something right there. In any case, be wary of anyone who sells you products too aggressively.
If you are planning to take supplements for therapeutic reasons, don’t look for the answers in this story.
You definitely need to start your search by looking for a professional who can help guide you.
Whom can I trust to give me straight answers about supplements?
Good question. Lots of consumers and researchers scratch their scalps over this one. Naturopathic physicians, who study plant medicine as a major part of their training, might be the best candidates. But if you live in the Midwest, forget it because naturopaths are not licensed to practice medicine in America’s heartland except in Kansas.
It’s possible that naturopaths will gain more of a foothold in the next decade. Ten states already license them, and New York and California are seriously considering it.
Until then, we are left with an inadequate mixture of not enough knowledgeable MDs, too few nutritionists willing to fill the gap (especially once the subject moves beyond vitamins and minerals), super-busy pharmacists and frightening numbers of homespun advisers (“my brother-in-law’s boss’ wife said St. John’s wort is good for back pain”).
But where there is a mess, there are cleaner-uppers. Dr. Tod Cooperman is a physician and founder of ConsumerLab.com, which is gaining respect among doctors and activists alike for providing some relief to supplement buyers.
For a relatively low cost ($7.25 for a specific one-supplement report or $17.95 for a yearly online subscription), you can visit the www.consumerlab.com Web site to see if the brand you plan to buy actually provides the stated amount of active ingredients.
His site lists both companies that pass and fail composition tests. The reports don’t address safety or effectiveness, but does assure buyers that’s what on the label is indeed in the bottle.
“One area consumers can go wrong is not understanding how products are labeled,” Cooperman said. “We want to fill the awareness gap.”
Getting the government to step in as a regulator
Another key question in the debate about supplements is whether supplements should be more closely regulated to protect consumers.
Although supplement sales are rising–the market has more than doubled since 1994–so is the number of warnings from the federal government about possible dangers of supplements. Talk about messes.
For instance, kava, just months ago touted as a natural stress reliever, reportedly can disrupt your liver function. Ephedra, a common ingredient in numerous weight-loss supplements and quick-energy powders, has been blamed for deaths and serious illness.
Just last month, the new Food and Drug Administration commissioner, Dr. Mark McClellan, declared open season on less-than-trustworthy supplement makers.
“Our focus is on trying to catch up on fraudulent or misleading claims,” said Christine Taylor, director of the Office of Nutritional Products, Labeling and Dietary Supplements at the FDA. “We are going to commit more resources to it. We will be going after some manufacturers and expect it will lead other [supplement makers] to make wiser decisions.”
The pivot point in government regulation is the Dietary Supplements and Health Education Act (shorthand is “dee-shay”) of 1994. The legislation broadly defined herbs and other botanical products as “dietary supplements.”
Although the FDA has relatively tight controls on food and medications, it has little ability to regulate supplements under DSHEA. Manufacturers are not required to prove their product’s safety or effectiveness before putting them on the market (the FDA can recall a product only once the government proves it dangerous).
Worse, by some researchers’ perspectives, supplement makers are not bound to any quality standards.
A threat to health
In a Dec. 19 position paper in the New England Journal of Medicine, co-authors Dr. Donald M. Marcus of Baylor College of Medicine in Houston and Dr. Arthur P. Grollman of State University of New York (SUNY) at Stony Brook called the broad inclusion of herbs as dietary supplements “a serious and growing public health problem.”
Eric Block, a professor of chemistry and noted herbal researcher at SUNY-Albany, said that too many supplements are still “out for the money” and that the government needs to find ways to enter the situation, even if it means repealing or amending laws.
“Government regulation is a sticky question,” Block said. “But someone needs to act independently [about the safety and effectiveness of herbs]. Look at kava. It is still out on the market.” (Other countries have banned kava from store shelves.)
Interestingly, DSHEA created an Office of Dietary Supplements (ODS) that is part of the National Institutes of Health. But the government organization has no regulatory power, leaving what little has been done to the FDA and the Federal Trade Commission (which can address advertising claims).
ODS’primary mission is guiding research, such as soon-to-be released comprehensive reports on the safety of ephedra and ephedrine and whether getting your omega-3 fats in fish or flax oil capsules is as effective as food sources.
The ODS is not widely known, but its director, Paul Coates, said he is hoping an increased budget of $17 million (up from $3.5 million in 1999) can help “give consumers appropriate information for their buying decisions.”
A series of ODS fact sheets will be available on its Web site, http://dietary-supplements.info.nih.gov, in coming months. Block is writing one on garlic, and a current posting details black cohosh, which is gaining scientific evidence as a herbal solution for hot flashes.
Coates said “a lot of people want to talk to us,” ranging from other government agencies to industry officials. From his vantage point, he expects the more responsible supplement makers to push for tighter quality controls and essentially self-regulate where government can’t or won’t.
Science to support claims
“The industry is conscious that supplement claims will need to be buttressed by good science,” Coates said. “The majority of makers know it doesn’t serve them well to be continually defending themselves. It creates a volatile market.”
Coates mentioned St. John’s wort. Only a couple of years ago it was a best seller, especially for mild to moderate symptoms of depression. But published studies about its adverse interaction with certain drugs have markedly dropped sales.
To date, Marcus and Grollman, in last month’s New England Journal article, offered the most sensible plan for upgrading regulation of the herbal marketplace without taking away consumer choice. They described a six-point plan that started with the basic requirement that all supplement makers and distributors register phone numbers and addresses with the FDA.
More substantive ideas demanded that manufacturers provide “evidence of good manufacturing practices,” report all adverse effects promptly to the FDA and conduct safety tests of products before going on the market, which is controversial but likely an inevitable choice as supplements continue to flood store aisles and computer screens.
Continued research is a must. Consumers need to make the best buying decisions they can in 2003, while the experts work on answering questions for 2004 and beyond.
“The key point is not to be spinning our wheels,” said Taylor of the FDA. “It might be important to know the correct dose of `X’ grams for substance `Y.’ But we still need to find out if substance Y is working. We’re still in the second train car and not the engine.”
— Bob Condor
