The hype over the health claims of food supplements

Numbering and threading would be good, but many of the conversations don’t get long enough to merit huge changes. Only when they mention quackery :o)

Guy – you are correct that the vast majority of Conversations have a small number of responses however as one does not know ahead of time which are going to generate comments perhaps it is sensible to number from the beginning.

If you have wished to follow up some of the remarks about duff appliances I cannot quote you particular comments as there again there are no numbers. You may feel quite miffed if I gave a link where there are 43 comments but I cannot identify which one I am talking about.

You will also note that Which? did not date the recent page on Washing at 60C which I find highly irritating I wonder why they do it? What reason is there not to date pages?
http://www.which.co.uk/home-and-garden/laundry-and-cleaning/guides/using-your-washing-machine/should-i-be-cleaning-at-60/

Is it something to do with reactive testing? This article from mid-July:
http://www.telegraph.co.uk/finance/personalfinance/consumertips/10187880/Is-it-really-cheaper-to-wash-clothes-at-30C-rather-than-60C.html

Patrick – Thanks for the insight on how to link. Unfortunately though it is hardly intuitive and though I can see its great value across threads I do wonder for a lot of people simply numbering would be adequate. In a thread such as we have currently numbering contributions would also signal that there are other entries being made in the conversation because the numbering would jump.

The method does not seem to be available on the readers views part of the website which over time may become a useful interaction point for readers and Which?.

” belabela wrote:
leak!
The morning after I bought it, there was a huge puddle of water in my kitchen. It leaks when you leave water in it. Unbelievable. I have never spent so much on a kettle and did not expect this kind of problem within 24 hours of buying it. I do not know whether I just picked a faulty one, I would love to see other reviews, but anyway I’m taking it back for a refund tomorrow.
15/2/2011 9:21 PM GST

http://www.which.co.uk/home-and-garden/kitchen/reviews/kettles/bosch-twk8631gb/customer-views/

Not really. The simple truth is that the vast majority of all supplements bought by consumers in the UK are not only completely unnecessary, they make no provable difference to people’s health.

You can tell because the labels say things like “can help support your immune system” – if it actually provably did support your immune system then it would have a much stronger statement, but the Code of Advertising Practice restricts them to claims that can be supported by robust evidence.

Guy,
“The simple truth is that the vast majority of all supplements bought by consumers in the UK are not only completely unnecessary, they make no provable difference to people’s health”.

That’s quite a bold statement which contradicts the evidence…………….

Makes you wonder why Obstetricians recommend nutritional supplements such as “Pregnacare Plus” as they did for my daughter during her own pregnancy.

And……….
Oral nutritional supplements provided to patients during hospitalisation is associated with significant reductions in length of stay and hospitalisation costs.
http://www.nutraingredients.com/Research/Health-economics-Nutritional-supplement-intervention-may-have-significant-benefits-in-hospital?utm_source=copyright&utm_medium=OnSite&utm_campaign=copyright

or this………
http://examine.com/supplements/

for example, the science and benefits of Vitamin C supplementation…………..
http://examine.com/supplements/Vitamin+C/#citations

http://www.crnusa.org/CRNPR12_CRN_Updated_Benefits_Report_062012.html

or even this………..
http://www.sciencedaily.com/news/health_medicine/dietary_supplements/

NHS offers only evidence-based treatments supported by NICE, whereas the private sector will do pretty much anything that’s legal as long as someone pays the bill.

Your GP may be able to refer you to a dietician, but in most cases treatments for menopause symptoms are becoming recognised as medicalising normal life and there’s much more focus on helping people to just live through them.

frenchlady,
the supplement that is reported to work very well for the menopause is listed here with testimonials…………
http://www.amazon.co.uk/product-reviews/B0013GAH12

Always assuming that the supplement industry is being honest about this, and that the supplements they sell actually contain what they claim.

And of course due to the supplement industry’s success in getting an industry-friendly regulatory framework, neither of these is at all dependable.

http://www.sciencebasedmedicine.org/new-concerns-about-the-safety-and-quality-of-herbal-supplements/

Chris, is this the same CRN organisation?
“The Council for Responsible Nutrition (CRN), founded in 1973 and based in Washington, D.C., is the leading trade association representing dietary supplement manufacturers and ingredient suppliers. CRN companies produce a large portion of the dietary supplements marketed in the United States and globally.”
If so, how can an organisation representing those with a direct financial interest in promoting supplements be cited as support for taking supplements? Or have I misunderstood your post and are you showing this up as a biassed source of advice?

Chris, the issue is whether parties with an interest in the outcomes might be selective in the material they choose to use that is helpful to their argument. I would prefer to see an independent peer-reviewed report for any issue that involves profit.

We already know that parties with a vested interest are not objective.
We also know that regulators are there to keep medicine more or less honest.
We also know that massive political lobbying by the supplement industry means that the supplement industry is virtually unregulated, to the point that many of their products, when tested, bear little or no relationship to what’s on the label.

The only thing we don’t know is why those who profess an interest in keeping medicine honest, give the supplement industry and other alternatives a completely free pass on this.

Yes I agree that parties with a vested interest are not necessarily objective; “vested interests” for the most part means any party/organisation/company that has a significant financial interest and incentive in their promotions and support.
In this respect, pharmaceutical companies have more of a vested interest than most if not all, because of patents and the extortionate sums acquired this way. I have mentioned before now that the major drug companies, spend more on advertising than on R&D.

The most prolific “political lobbying” by far is from the pharmaceutical companies where the total lobby dollars spent between 1998 and 2012 was $5.3 billion, or nearly three times greater than the second most generous industry: insurance, and well above Oil and Gas at $1.4 billion, and Securities and Investment at $1.0 billion.

Supplement lobbying pales into insignificance in comparison.

You will have to substantiate your claim that many supplement “products, when tested, bear little or no relationship to what’s on the label”, to have any credibility, quoting sources please.

The supplement industry probably needs more regulation to ensure a consistently high standard of quality, but you seem to be unaware of the new regulation gradually being imposed by the EU.

This is also the case within the United States, where since 2007, manufacturers are required to evaluate the identity, purity, quality, strength, and composition of their dietary supplements’ ingredients and finished products to be compliant with the Current Good Manufacturing Practices in manufacturing, packing, labeling, or holding operations for dietary supplements. One aspect of this evaluation can involve the use of NIST Standard Reference Materials http://www.nist.gov/srm/) as controls. Laboratories must also demonstrate analytical proficiency.

In addition, the need for the regulation of dietary supplements is not quite the same as the need for the regulation of drugs, because they are identified as “foods”; it is for this reason that they are known as supp-le-ments, because they supp-le-ment the diet.

When critics state that dietary supplements are “unregulated,” what they generally mean is that dietary supplements are not regulated like drugs. This is true, because dietary supplements are regarded and regulated as food, not drugs.

DSHEA defines dietary supplements as products intended to supplement the diet.
According to DSHEA, dietary supplements may contain vitamins, minerals, herbs or other botanicals, amino acids, other dietary substances, or combinations or extracts of any of these “dietary ingredients.”

Drugs have to be highly regulated because of potential toxicity and serious harm as a result, and as I have highlighted before now.
Supplements on the other hand are for the most part non-toxic, with a few exceptions such as Vitamin A and Iron.
Supplements as foods are not drugs, although some seem to equate the two as being synonymous.

No, Chris, when we say that supplements are not regulated, what we mean is that they are basically not regulated. The US market is worst: not only do vendors not have to prove their products are safe, the FDA actually has to prove they are harmful in order to get them controlled – and then they just slightly reformulate them and start right back up.

Herbs have potential toxicity, supplements have potential toxicity, quack remedies sold as supplements have potential toxicity. Simply slapping a “natural” badge on it does not change anything.

There have been substantial harms documented due to supplements such as aristolchia, DMAA, black walnut. The last was found as an undeclared ingredient in random testing of supplements – a test which found that of 12 companies whose products were sampled, only two were authentic.

A study of 131 herbal teas revealed only 58% of products could be authenticated, and 33% were contaminated.

A study of 40 “black cohosh” supplements noted that 25% were substituted with related species.

Half of the ginseng products examined in one study contained other forms of ginseng than the labelled Panax ginseng.

A 2005 survey of 230 Ayurvedic medicines found that 20% were contaminated with heavy metals such as lead, mercury and arsenic.

I support a completely level playing field: every claim held to the same standards, every medicinal product required to demonstrate safety and efficacy. Don’t you think that’s a good idea? Big Herba has the money, they just spend it on marketing instead of science.

You have highlighted some issues of contamination with some supplements, but these are isolated cases and not widespread.

I refer to my earlier post which points out that the EU is currently in the process of regulating supplements, and in the United States where supplement manufacturers have to comply with GMP’s (Good Manufacturing Practices) and Laboratories must also demonstrate analytical proficiency, and held to account if this is not the case.

I also support a completely level playing field: so every claim should hold to the same standards, and every medicinal product required to demonstrate safety and efficacy, and a good idea of course.

So you say. But then a test of a decent sized random sample found that the vast majority did not contain what they said n the label.

Of course, if they were regulated like real medicinal products, we’d know, we’d have full assays available, and licenses would be withdrawn for failure to comply.

I know, level playing field, crazy talk. Much better to let the supplement industry do what it likes, it makes a lot more profit for its shareholders in the senate that way.

The supplement market is a multi-billion dollar market, and the money it spends on lobbying and advertising, it can afford because it spends practically nothing on research.

The idea of “big pharma” versus “little farmer” is cute, but wrong.

Check the sources in this blog post re research numbers. http://www.skepticnorth.com/2011/02/bankers-buyouts-billionaires-why-big-herba%E2%80%99s-research-deficit-isn%E2%80%99t-about-the-money/

I have no idea why vendors of “alternative” products get a completely free pass on conflicts of interest from those who rail against them in medicine.

It is true of course that the supplement market is a multi-billion dollar global market, and in terms of %, they spend much less on R&D when compared to Pharmaceuticals and with good reason.

Nutritional research is mostly being done by Universities around the World, so we already know the benefits of the Vitamin B Complex or Vitamin A or any other type of Vitamin or Mineral: this is ongoing research by academic institutes in the role played by individual nutrients in human health or combinations of the same.
One example would be Astaxanthin, (a carotenoid phytochemical found in plants) where research has been conducted by the School of Food Science, Washington State University,
http://www.ncbi.nlm.nih.gov/pubmed/20205737

Annual sales of Pharmaceuticals are approx’ $430 billion, whereas the annual sales of Supplements amount to approx’ $38 billion, but the % of cost of R&D of the latter could and probably should be higher, so in that regard I would agree with you.

R&D costs of Pharmaceuticals probably need to be higher anyway, because of the risk of toxicity and potential harm, whereas the risk of toxicity and potential harm from supplements is far lower, and which have a history of safety and efficacy of use in comparison.

This is not to say that the Supplement Industry do not behave in the same way as the Pharmaceutical Industry, where the profit motive seems to take a leading role, and if so, both should be brought to account.

What the supplement industry mainly does is leave cranks to make inflated claims for supplements, and then advertise them on an availability basis.

The “history of safety and efficacy” assumes that safety and efficacy are proven. In fact, neither is the case. As I pointed out before, a study found that only 2 of 12 manufacturers of herbal supplements were shipping what was advertised on the label, many products contained none of the supposed ingredient at all, others were adulterated with products that have known side effects or cause withdrawal symptoms when stopped. DMAA and aristolchia have caused fatalities, there is evidence of heavy metal contamination in ayurvedic products and so on.

There is no credible rationale at all for failing to apply a similar standard to all medicinal products. Herbal remedies are medicinal products, yet they can be sold without evidence of either safety or efficacy, quite legally; usually the medicinal claims are made at arms-length via crank websites often run by people who have highly lucrative supplement sales businesses (Mercola and Adams, for example).

I do not believe that slapping a “natural” label on something earns it a free pass from scrutiny. I think it’s fine for science to test any medicinal claim. Any claim supported primarily by vested interests, which applies to drugs and supplements equally, should be subject to the strongest scrutiny, and science originating wholly within that culture should be checked independently wherever possible.

That’s how we know Vioxx is dangerous and goji is a waste of money. I am happy to know these things.

If the supplement industry mainly use cranks to make inflated claims for supplements or superfoods then Professor Robert Thomas, a consultant oncologist at both Bedford Hospital and Addenbrooke’s, part of Cambridge University Hospital must be a crank then?

Goji berries a waste of money!!

Here’s a sampling to be getting on with……………………

An RCT no less………….
http://www.ncbi.nlm.nih.gov/pubmed/18447631

RESULTS: Significant differences between day 1 and day 15 were found in the GoChi group (N = 16) in increased ratings for energy level, athletic performance, quality of sleep, ease of awakening, ability to focus on activities, mental acuity, calmness, and feelings of health, contentment, and happiness. GoChi also significantly reduced fatigue and stress, and improved regularity of gastrointestinal function. In contrast, the placebo group (N = 18) showed only two significant changes (heartburn and happiness). No significant changes in musculoskeletal or cardiovascular complaints were observed in either group. All parametric data (body weight, etc.) were not significantly different between groups or between day 1 and day 15 for either group.
CONCLUSIONS:
These results clearly indicate that daily consumption of GoChi for 14 days increases subjective feelings of general well-being, and improves neurologic/psychologic performance and gastrointestinal functions. The data strongly suggest that further research is indicated to confirm and extend knowledge of the potential effects of Lycium barbarum upon human health.

Scientific Research on Goji–“lycium barbarum”
http://www.gojitrees.com/RichNatureCerts/Research%20and%20References%20on%20Goji%20Science.pdf

Studies Involving Goji Berries…………….
http://www.gojijuices.net/gojijuiceresearch.html

More studies………….

Amagase H, Nance DM. “A randomized, double-blind, placebo-controlled, clinical study of the general effects of a standardized Lycium barbarum (Goji) Juice, GoChi.” Journal of Alternative and Complementary Medicine. 2008;14:403-412.

Chang RC, So KF. “Use of Anti-aging Herbal Medicine, Lycium barbarum, Against Aging-associated Diseases. What Do We Know So Far?” Cellular and Molecular Neurobiology. 2008;28(5):643-52.

Ho YS, Yu MS, Lai CS, et al. “Characterizing the neuroprotective effects of alkaline extract of Lycium barbarum on beta-amyloid peptide neurotoxicity.” Brain Research. 2007;1158:123-134.

Li XM, Ma YL, Liu XJ. “Effect of the Lycium barbarum polysaccharides on age-related oxidative stress in aged mice.” Ethnopharmacology. 2007;111:504-511.

Love the white coat in the youtube video: it gives the speaker an air of authority that would probably be absent if she was in plain clothes.

Superfoods?

This depends on what is meant by that term, but here’s one example on Spirulina and the science that supports its ingestion………….
http://www.superfoods-scientific-research.com/green-foods/spirulina-joins-cancer-fight.html
http://www.superfoods-scientific-research.com/green-foods/spirulina-helps-boost-immunity.html
http://www.superfoods-scientific-research.com/green-foods/spirulina-therapeutic-properties.html

Pomegranate, green tea, turmeric and broccoli……………..
UK scientists show super foods proven to beat prostate cancer.
http://www.cuh.org.uk/cms/news/cancer-services/uk-scientists-show-super-foods-proven-beat-prostate-cancer

Ranked as one of “America’s Best Hospitals” in cancer by U.S.News & World Report………

Mushrooms may slow the growth of breast cancer, blueberries could slow down the spread of cancer and grape seed extract might starve cancer cells.
http://nationalevents.cityofhope.org/site/PageServer?pagename=walk_super_foods

A Harvard School of Public Health study published in the January 2013 issue of Circulation: Journal of the American Heart Association, finds that three or more servings of blueberries and strawberries per week may slash a woman’s risk of heart attack by as much as 33%. Researchers attributed benefits to the berries’ high anthocyanin content, which may help dilate arteries, counter the buildup of plaque and provide other cardiovascular benefits.
http://circ.ahajournals.org/content/127/2/188.full
http://www.wildblueberries.com/health/research.php

Just a sampling of current scientific research into the health-benefits of “superfoods”.

What, a website devoted to promoting superfoods claims there’s loads of evidence supporting superfoods? Who predicted that?

Leaving aside for a moment your pathological skepticism towards evidence conflicting with your worldview, goji is under serious scrutiny for the marketing claims made (see sections in https://en.wikipedia.org/wiki/Goji), “miracle” antioxidant source acai contains less antioxidants than many much cheaper products (see sections in https://en.wikipedia.org/wiki/A%C3%A7a%C3%AD_palm) and so on.

If you always believe websites promoting “miracle” supplements you will of course only ever hear that they are “miraculous”. The question is, why do the commercial interests promoting these products get a free pass when in any medical intervention, the taint of commercial interests is a trigger for pathological skepticism?

It is more than likely that you are looking at the wrong websites Guy; they are not promoting superfoods, just examining the science behind them.

Unless of course you think that Professor Robert Thomas, a consultant oncologist at both Bedford Hospital and Addenbrooke’s, part of Cambridge University Hospitals is marketing them himself?

The other links with research provided by Cityofhope are ranked as one of “America’s Best Hospitals” in cancer by U.S.News & World Report.

Must try harder.

Thank you.

Your view of the “right” websites to use for reference is radically different from mine. Oddly, mine seem to have more references to equivocal and disconfirming studies and information, and this applies across the board (medicine and alternatives).

“Must try harder” to believe the claims of salesmen, unsupported by scientific consensus? No, I don’t thinks so, thanks all the same.

Guy,
The website for Cityofhope is ranked as one of “America’s Best Hospitals” in cancer by U.S.News & World Report, and Professor Robert Thomas, is a consultant oncologist at both Bedford Hospital and Addenbrooke’s, part of Cambridge University Hospitals.

So by your own definition, these are salespeople for “miracle foods”?

Your logic leaves much to be desired.

Chris, this is a mess of special pleading. Doctors (and especially the dieticians to whom they refer people with complex dietary issues) know massively more about human health than the average vitamin peddler, and have no vested interest in one form of treatment over another: they get paid according to the people they treat, no the way they treat them.

The basis of the claims that science “doesn’t understand” this or that magic supplement basically comes down to the fact that science doesn’t accept as gospel the views of its proponents.

The rules in place are if anything too weak, and they are routinely ignored by the supplement industry. I have a very hard time accepting the assertions of those whose advertisements lack credible evidence, that they should be allowed ot use a weaker standard of evidence because Natural.

Guy, it looks as if you haven’t understood the previous post by ‘Chris’. Not a ‘mess of special pleading’ at al, but carefully and clearly set out. As a professional scientist, I find his arguments, and the manner in which evidence is cited in support, detailed, interesting, thought-provoking and worthy of follow-up.

Thank you Mel, that is very encouraging.

As Mel has mentioned Guy, this is most definitely not a “mess of special pleading”.

I have become accustomed to your generalized sweeping statements that avoid the crux of the issues at hand, but then it would seem you resort to any measure or argument not to accept the evidence I have presented. I will leave others to arrive at their own conclusions as to why this is the case.

Further, I would say that although Dietitians are highly qualified in dietetics and nutrition, I have reservations about some of their advice (and therefore credibility) when, (for example) they recommend junk confectionery laden with white sugar to cancer patients at the Royal Marsden Hospital, in the mistaken belief that this will “give them energy”.
Whether Dietitians know more about nutrition and how this affects human health is debatable when compared with other qualified nutritionists, such as those who advocate disease-reversing plant-based diets such as: Dr C B Esseltyn MD http://www.heartattackproof.com/ ;
Dr Joel Fuhrman MD http://www.drfuhrman.com/disease/default.aspx; Dr Dean Ornish MD, whose way of eating was rated #1 for heart health by U.S. News & World Report in 2011 and 2012.
Not a Dietitian anywhere in sight.

The “Vitamin peddlers” that you refer to, usually have science on their side and manufacture supplements based on that evidence. This fills a perceived need in nutritional therapeutics, such as with nutraceuticals, not obtainable from what you and they refer to as a “balanced diet”.
http://news.cision.com/the-investor-relations-group/r/standard-american-diet-inadequate-to-maintain-health–say-experts,c9218671 ; and more.

Your comment……….

“The basis of the claims that science “doesn’t understand” this or that magic supplement basically comes down to the fact that science doesn’t accept as gospel the views of its proponents”.

Science does in fact understand the wealth of nutrition concerning human health, but it is still in its infancy. Your use of the term “magic supplement” speaks volumes on your opinion here, and it is only “opinion”, as there is no such thing.

The supplement industry is not perfect Guy, but they are at the “cutting edge” of research into how these are of huge benefit for health and the treatment of disease; such as with non-toxic nutraceuticals and botanicals which offer a viable alternative to toxic dose-dependent pharmaceuticals, and where the latter companies perceive them as “competition”, and strive to have them suppressed to non-therapeutic levels of use, in the interests of monetary gain.

Guy,
almost 60% of experts sitting on the European Food Safety Authority’s (EFSA) panels have direct or indirect links with industries regulated by the agency, according to an independent screening performed by Corporate Europe Observatory (CEO) and freelance journalist Stéphane Horel. The report “Unhappy Meal. The European Food Safety Authority’s independence problem”identifies major loopholes in EFSA’s independence policy and finds that EFSA’s new rules for assessing its experts, implemented in 2012 after several conflicts of interest scandals, have failed to improve the situation.

Many are now of the opinion that this is the sole reason that the system of scientific evaluation on the health-claims of food products and supplements, has been based on a pharmaceutical model for proof of efficacy, rather than including other scientific sources of efficacy, so that many health-claims would not be permitted.

Operating outside the basic principles of freedom and democracy, the Brussels EU seems to have become a dictatorship. Neither the 27 ‘Commissars’ making up the European Commission, the executive level of the Brussels EU – nor even the Brussels EU President, Herman van Rompuy – have been elected by the people. Instead, the power of the people to determine their government has effectively been transferred to corporate interests. The control of EFSA’s panels by representatives of the very industries it claims to be regulating is a classic example of this.

Not too sure as to your reasoning here Dave as politics has little to do with health, and whoever is in power.
Government ministers take the advice of civil servants who support and a part of the status quo, and in health matters the Chief Medical Officer, affiliated to Mainstream medicine.

Nutrition is an emerging and growing Science still in its relative infancy, but has to compete with established pharmaceuticals and pharmaceutical-therapy (a mainstay of Modern Medicine). In fact the entire system of Medicine revolves around pharmaceuticals and their treatment of disease.
Nutrition and Nutraceuticals in particular are perceived by the pharmaceutical companies as competition, resulting in the proposed and implemented draconian measures by EFSA in restricting the MPUL’s (maximum permitted upper levels) of nutrient-supplements to non-therapeutic low-dose levels.
This is being done on the alleged grounds of “safety”, when in comparison to prescribed medications, they have an outstanding safety record already.

My MEP has also communicated to me personally, that the lobbying efforts by the pharmaceutical companies within the EU (and elsewhere) are extremely influential and powerful in having his fellow MEP’s to act and vote in their favour.
http://www.aefjn.org/index.php/358/articles/id-1the-influence-of-pharmaceutical-corporations-in-health-policies.html

In addition, a friend of mine who was a long-standing senior manager in my local Primary Care Trust, has openly admitted that the drug companies possess a great deal of power and influence in health matters and Medicine generally, so they are unlikely to endorse or support therapies that act as competition to their wares.
http://www.theguardian.com/society/2013/apr/05/drug-companies-pay-doctors-40m

The Labour Party, although in power for 13 years or so under Tony Blair, actually endorsed the status quo in medicine of pharmaceutical influence, so whichever political party has been in power, it makes little if any difference to established medicine and how disease and health are treated.