by Micaela Young
How can the multi-billion dollar supplement industry grow exponentially while its consumers become more and more unhealthy? More so than not, the name of the game is money and they will do, and say, anything to keep you hooked. Toto, you’re not in Kansas anymore.
Before moving to Boston to begin studies at the Friedman School, I was employed at a pharmacy and natural product store where I learned the ins-and-outs of the supplement industry. We practiced real quality control on the products sold and recommended, which involved requiring laboratory results for content and contamination. Visiting facilities where the supplements were being produced was also not uncommon, as was checking for the environmental sustainability of the inputs. For example, fish oil would not be on our shelves if it had a high acid value, an indicator of inadequate processing or storage conditions, or if the fish supply came, say, from off-shore trawlers hurting local economies and ecosystems in Peru.
To avoid making frivolous supplement recommendations, we also first counseled patients on diet and lifestyle choices. I was really excited to share my newfound knowledge with patrons.
However, I soon found that many customers were not interested in advice. Instead of first trying to make minor changes such as increasing vegetable consumption, clients were more interested in reaching for a multivitamin. Why eat a balanced diet if you can just take a pill?
We are a society of “instant gratification” in many respects. Multivitamins fit into this fast-paced lifestyle perfectly. At what point, however, do we stop to ask ourselves: What are we putting into our bodies?
Multivitamins have the potential to be especially valuable for the elderly and those who are not reaching their dietary needs through food, but most of the marketing of supplements is based on weak evidence of actual personal benefit while projecting a far stronger profit potential. The industry’s efforts are paying off, with dietary supplement use having risen dramatically in recent decades. According to the NCCIH, a majority of us take a supplement daily with approximately 40% of American adults using multivitamins. By 2021, the Nutritional Business Journal projects that revenue for nutritional supplements will double from $32 billion in 2012 to a whopping $60 billion.
Take a walk down any health or drug store supplement aisle, and you will see countless different kinds of vitamins, some with images of fruits and vegetables on the packaging promising to contain whole foods. Others, more mainstream vitamins, boast to increase your energy, immunity and whole body health. In truth, these “natural” and “whole food” vitamins contain compounds made in a lab that are not present in the same forms and proportions that you can find in food, so we have to ask: are their promises too good to be true?
Each nutrient in its whole food form is made up of a complex interworking of compounds. For example, Vitamin E is made up of 9 tocopherols and tocotrienols, supporting lung and skin health among other important health-benefits. When you buy a standard multivitamin in the store, the “Vitamin E” it contains is made up of only one solitary molecule of dl-alpha tocopherol. This isolate form has been linked to an increased risk of prostate cancer, according to a study published in 2011 by the Journal of the American Medical Assocation (JAMA).
Calcium supplementation has also been shown to have an inverse or null association with cardiovascular outcomes in observational studies. A study published by Li Kuanrong and colleagues (2012) investigated supplemental calcium’s impact on myocardial infarction (MI) risk. Adjusting for dietary calcium intake, which the study notes has been associated with lowering hypertension, the investigators found calcium supplement users were correlated with a higher heart attack risk to which they attributed the spike in calcium serum levels after taking a supplement versus eating calcium-rich foods. While this study did not collect data on calcium supplement doses, a meta-analysis done previously by Bollard and colleagues (2011) also found similar conclusions. JAMA also published a study by Xiao, et.al. (2013) associating a higher risk in cardiovascular death in men with high-dose calcium supplementation.
In 2013, the U.S. Preventative Task Force did evidence reviews and a meta-analysis of calcium and vitamin D supplementation to make a recommendation statement for fracture prevention in adults. The Task Force concluded that there was insufficient evidence to assess the pros and cons of combined supplementation as a primary prevention method.
In addition, three studies published by the Annals of Internal Medicine in 2013 found no benefit for multivitamin supplementation over placebos in cognitive function enhancement, or in cardiovascular disease and cancer prevention. JAMA also published a study in October 2011 entitled “Dietary Supplements and Mortality Rate in Older Women” which found that multivitamin use was modestly correlated with total mortality risk in women, clearly establishing concern for the lack of research done on the long-term effects of vitamin use, including iron and other mineral supplementation.
While more thorough, prospective and long-term research is needed, studies indicate reasonable doubt as to whether filling in the gaps of a less-than-perfect diet with supplementation offers any sort of health benefit.
During my “gap” year at the pharmacy, I worked under Josh Boughton who is a leading industry expert and owner of a consulting business for supplement companies. When asked to spill some industry dirt, Josh said that “Big Pharma spends millions of dollars every year convincing people that they need high dosages of ‘natural vitamins’ in order to be healthy. In fact, pharmaceutical and chemical companies manufacture the vast majority of raw materials that go into supplements. Yes, even health-food store and naturopath supplements.”
He also goes on to point out that health-food store vitamins are no better than the ones sold in drug stores, “There are companies on the market who pretend to sell whole-food vitamins. In fact, what they are doing is just feeding those same synthetic vitamins to yeast as a growth medium, mixing a spec of food in at the end and then calling it raw, whole-food supplements. They are outright lying. This is part of the marketing plan. In fact the same chemical companies sell to both types of products. The B-50 Vitamin B Complex you get at a drug store or at a health food store are no different at all. The only thing that changes is the fillers and the packaging. I know it’s hard to believe, but its true.”
Under the Dietary Supplement Health and Education Act (DSHEA) of 1994, supplement companies were freed from the requirement to prove that a product is safe, rather leaving it up to the already burdened FDA to prove that it is unsafe. While companies cannot make product claims such as “cures obesity” or “prevents heart disease,” they are allowed to make health-related claims instead, like “supports a healthy weight” or “helps to maintain healthy cholesterol levels.” Thus, the deliberate dishonest marketing and the misuse of scientific findings to confuse and take advantage of consumers, both by big companies and individuals who market false products, resulted. The masquerade begins with the coating the vitamins are swathed in, to how much viable product is actually contained in those capsules.
How easy is it to be deceived? Well it apparently takes a village…or the New York State Attorney General’s Office. The New York Times article about herbal supplements and the lack thereof that went viral in February of this year clued us in to the unreliable nature of the supplement industry and its products.
My advice? Be vigilant and open-minded. Do your research to find out if the vitamins you are taking are in the best form and doses for the desired therapeutic results. For instance, you wouldn’t want to be taking magnesium in the form of magnesium oxide, clinically used as a laxative, in a multivitamin or to treat muscle cramps.
Better yet, eat a balanced diet. Be sure to eat a variety of fresh fruits and vegetables daily, as nature intended. Toto, you may not be in Kansas anymore, but hit up the Farmer’s Market regardless…
Micaela Young is a first year NUTCOM student and ACSM personal trainer. She is a competitive runner and avid eater who hopes to one day be a force for changing our current food culture.