It is always a challenge to find a catchy headline for an article. For this one, a connection to the classic 1966 “spaghetti western” that propelled Clint Eastwood to fame seems fitting. The film is about three gunslingers who battle each other as they look for a stash of gold. “The Good, The Bad and the Ugly,” is a great title that I hereby propose to swipe because I think it also captures the essence of the “health supplement” industry. Some supplements are potentially useful, some are useless, and some are outright ugly. But when it comes to profits, there is gold to be had, and marketers battle each other for it in pharmacies, health food stores and online. Their weapons are not guns, but claims, often outlandish, of enhanced health.
Let’s start with the really ugly. “Miracle Mineral Solution (MMS)” is widely hyped as a remedy for virtually any ailment, including COVID-19. It comes in two bottles, one containing citric acid, the other sodium chlorite. Mixing these produces chlorine dioxide (ClO2), the “miracle.” Widely used as an industrial bleach, chlorine dioxide has no medicinal value and is potentially hazardous. After receiving numerous reports of consumers getting sick, both Health Canada and FDA have issued warnings about MMS being a dangerous and fraudulent product.
Some weight loss and sports supplements also fall into the “Ugly” category because they contain unapproved stimulants such as deterenol, phenpromethamine and dimethylamylamine (DMAA). These are in the amphetamine family and pose a cardiac risk. Deterenol is sometimes listed on the label even though it has been banned from supplements, while the others are not listed. Some “brain boosters” have been found to contain unapproved drugs such as aniracetam and vinpocetine. While particularly disturbing when it comes to undeclared physiologically active ingredients, the problem of what supplements actually contain is widespread. Since these products are not regulated the same way as drugs, you never know exactly what you are getting. A recent study by the U.S. Government Accountability Office found that one Ginkgo biloba supplement tested contained no ginkgo at all, while several others contained less than indicated on the label. It should also be noted that there is no evidence that Ginkgo supplements in any dose improve cognition as claimed.
That segues us into the “Bad” category. Here we encounter a host of supplements that make false claims or have no significant supportive evidence. Prevagen, an extensively advertised memory enhancer with a supposed active ingredient isolated from jellyfish, bases its claim of improved memory on a study that found it to be no better than placebo until the data was tortured to reveal some benefit is a subgroup analysis. This sort of “data-mining” is a common practice when searching for a positive result. The fact that in twenty-seven subgroups Prevagen showed no benefit is conveniently forgotten. Furthermore, the “active ingredient,” in truth a misnomer, is indeed found in jellyfish but is not isolated from this source. It is produced synthetically, not that this is relevant. The producers of Prevagen recently settled a class-action lawsuit and refunded consumers who claimed they had been misled. That, though, did not put an end to the endless, nauseating ads on television, and undoubtedly the money keeps rolling in. Maybe people who have memory issues and buy Prevagen don’t remember that they have bought it before and experienced no benefit.
Vitamin E and beta-carotene are set to join Prevagen on the “Bad” list. These supplements are usually promoted for their supposed help in preventing cardiovascular disease (CVD) and cancer. But now the U.S. Preventive Services Task Force (USPSTF), a group of highly qualified experts that gives recommendations Congress, has concluded that “supplementation with vitamin E provides no benefit, and the harms of beta-carotene supplementation outweigh any benefits for the prevention of CVD and cancer.” When it comes to supplementation with multivitamins, the conclusion is that “there is not enough evidence to determine the balance of harms and benefits for CVD and cancer prevention.”
So, are there any supplements that fall into the “Good” category? Certainly, there is evidence that folic acid supplementation during pregnancy reduces the risk of some major birth defects, and while not conclusive, there is evidence that vitamin D supplements at the recommended doses pose no risk and may provide benefits, particularly when exposure to sunshine is limited. In other instances, when tests show low blood levels, vitamin B12 being an example, supplements are indicated.
With a measure of trepidation, some herbal products may squeeze into the “Good” grouping. Plants are veritable chemical factories and many prescription drugs are either extracted from plants, morphine for example, or like levodopa, are synthetic versions of molecules found in plants. It is, therefore, reasonable to assume that some herbal supplements may have health benefits, but the problem is evidence. In the U.S. herbals can be put on the market as “dietary supplements” without having to provide any evidence, and while in Canada some evidence is required to obtain a Natural Health Product (NPN) license, the bar is set very, very low. Traditional use, non-peer-reviewed publications, or theoretical plausibility can suffice. In some cases, for example, ashwagandha root, the evidence is more robust. The powdered root has a long history of use in Ayurvedic medicine as an anxiety reliever, sleep enhancer, muscle strengthener, and immune booster that is actually backed up by some clinical trials, albeit not of high quality. There seems to be no issue with safety.
These are just a few illustrative examples of the problems with supplements. Similar issues can be raised about many of the 80,000 or so others on the market. This is underlined by a recent report on “natural health products” presented to Parliament by the Office of the Auditor General of Canada. The scathing conclusion is that Health Canada “has not ensured that natural health products offered to Canadians were safe, effective, and accurately represented on the basis of appropriate evidence.” Basically, buyer beware!
Summing it all up, when it comes to navigating the claims of health supplements, it is like riding through the Old Wild West. There are few rules and much of the time, anything goes. Some law and order is needed. Unfortunately, the Sheriff is dosing. And even when awake, he is often firing blanks. At least in the movie, the “Good” guy wins, but as with the supplements, it turns out that he is not all good.