I’m often asked what my opinion
about a diet or disease is.
Who cares what my or anyone else’s opinion is.
All we should care about is what the science says.
What does the best available balance of evidence
Published in the peer- reviewed medical literature
have to say right now?
Welcome to the Nutrition Facts Podcast,
I’m your host, Dr. Michael Greger.
Today we examine the sketchy supplement industry.
And by sketchy, I don’t mean artistic.
In our first story, we take a close look
at the industry’s attempts to rebut an editorial
in an alternative medicine journal.
An editorial was recently published decrying much of the multibillion dollar marketing
of dietary supplements in North America as misleading, deceptive — even predatory.
After examining hundreds of sales claims made when supplements are being marketed
over the years, the author concluded: "Dishonesty or wild exaggerations are
frequent occurrences in the marketing of supplements."
My favorite quote was: "The marketers of supplements like to use scientific
evidence the way a drunk uses a lamp-post: more for support than illumination."
This is nothing new.
Similar editorials have been published in the Journal of the American Medical
Association and the New England Journal of Medicine.
What made this special was that it was, to their credit, published in
the Journal of Alternative and Complementary Medicine.
It’s like their own journal admitting it!
In response, the Head of Global Supplement Initiatives at Novus, which actually
started out as the livestock feed additives division of Monsanto, before
branching off into human feed additives — dietary supplements — starts his rebuttal
with this counterpoint: "In his review entitled ’The Marketing of Dietary
Supplements in North America: The Emperor is (Almost) Naked,’ [the author] may be
mortified to know the emperor is still dancing in the street, dressed or not,
to the tune of $68 billion.
This figure is much higher and is a more relevant number than cited… indicating
a very strong and respectable commerce."
That’s his first argument?
That it’s highly lucrative?
He goes on to say that hey, they’re safer than some pharmaceuticals.
But how much is that saying, given that prescription drugs kill an estimated
106,000 Americans every year?
And that’s not errors; not abuse; not overdose.
That’s just deaths from side effects, ADRs (adverse drug reactions), which
would make doctors — me and my fellow colleagues — the fourth leading cause
of death in the United States.
So, for the supplement industry to say, "Hey, at least we’re not the fourth
leading cause of death," isn’t saying much.
Next up, calcium supplements.
Might they increase the risk of heart attacks?
Here’s the story.
In 12 short years, government panels have gone from suggesting widespread
calcium supplementation may be necessary to protect our bones to
"Do Not Supplement." What happened?
It all started with a 2008 study in New Zealand.
Short-term studies had showed that calcium supplementation may drop
blood pressures by about a point, though the effect appears transient,
disappearing after a few months, but it's better than nothing.
And excess calcium in the gut can cause fat malabsorption,
by forming soap fat, reducing saturated fat absorption
and increasing fecal saturated fat content.
And indeed if you take eat a couple Tums along with your half bucket of KFC,
up to twice as much fat could end up in your stool.
And with less saturated fat absorbed in your system your cholesterol might drop.
So the New Zealand researchers were expecting to lower heart attack rates
by giving women calcium supplements.
To their surprise there appeared to be more heart attacks
in the calcium supplement group. Was this just a fluke?
All eyes turned to the Women's Health Initiative, the largest and
longest randomized controlled trial of calcium supplementation.
The name might sound familiar. That's the study that uncovered
how dangerous hormone replacement therapy was.
Would it do the same for calcium supplements?
The Women's Health Initiative reported no adverse effects.
However, the majority of the participants
were already taking calcium supplements before the study started,
so effectively the study was just comparing higher versus
lower dose calcium supplementation,
not calcium supplements versus no calcium supplements.
But what if you go back and just see what happened to the women
who started out not taking supplements and then were randomized
to the supplement group?
Those who started calcium supplements suffered significantly
more heart attacks or strokes.
Thus, high dose or low dose, any calcium supplementation seems
to increase cardiovascular disease risk.
So researchers went back digging through other trial data for heart attack
and stroke rates in women randomized to calcium supplements,
with or without vitamin D added, and confirmed the danger.
And most of the population studies agreed:
users of calcium supplements tended to have increased rates
of heart disease, stroke, and death.
The supplement industry was not happy,
accusing the researchers of relying in part
on self-reported data -- like they just ask if people had a heart attack or not
rather than verifying it.
And indeed long-term calcium supplementation
causes all sorts of gastrointestinal distress
including twice the risk of being hospitalized with acute symptoms
that may have been confused with a heart attack.
But no, the increased risk was seen consistently
across the trials whether the heart attacks were verified or not.
OK, but why do calcium supplements increase heart attack risk,
but not calcium you get in your diet?
Perhaps because when you take calcium pills,
you get a spike of calcium in your bloodstream
that you don't get just eating calcium rich foods.
Within hours of taking supplemental calcium, the calcium levels
in the blood shoot up and can stay up as long as eight hours.
This evidently produces what's called a hypercoaguable state -- your blood clots
more easily -- which could increase the risk of clots in the heart and brain.
And indeed higher calcium blood levels
are tied to higher heart attack and stroke rates.
So the mechanism may be calcium supplements
leading to unnaturally large, rapid, and sustained calcium levels in the blood,
which can have a variety of potentially problematic effects.
Calcium supplements have been widely embraced on the grounds that
they are a natural and therefore a safe way of preventing osteoporotic fractures.
But it's now becoming clear that taking calcium in one or two daily doses
is not natural, in that it does not reproduce the same metabolic effects
as calcium in food -- the way nature intended.
And furthermore the evidence is also becoming steadily stronger
that calcium supplementation may not be safe.
That's why most organizations providing advice regarding bone health
now recommend that individuals should obtain their calcium requirement
from diet in preference to supplements.
Finally today, black raspberry supplements are put to the test.
The regulation of dietary supplements in the United States
has been described as too little, too late.
Dietary supplements may be adulterated
with dangerous compounds, be contaminated,
fail to contain what they say they contain,
contain unknown doses of the ingredients
listed on the label,
be sold at toxic dosages,
or produce harmful effects in other ways.
This not only messes up any research done on them,
but can put the general public at risk.
A third party company that has tested
thousands of supplements,
identified approximately 1 in 4 with a quality problem,
either not containing what it says
or contaminated in some way – 1 in 4.
For example, I’ve done a few videos
on the remarkable properties of black raspberries.
Can’t always find them fresh or frozen;
so how about black raspberry supplements?
You go to the store or look online.
How about this one?
Fresh, raw, pure— that sounds good.
Let’s look at the back.
It says it contains just seedless black raspberry powder
and absolutely nothing else – exclamation point!
It’s nice to see there are no fillers
or artificial ingredients.
So, you plunk down your $23.77,
but it turns out you’ve been had.
The first clue was that the picture
on the front was actually blackberries photoshopped
to look like black raspberries—
they couldn’t even be bothered to put a real image
on their fake supplement.
The researchers' second clue was that it sure didn’t look
like pure black raspberry powder;
and so, they put it to the test,
and indeed, there was no black raspberry at all.
Instead of absolutely nothing else,
they should have just stopped with
"This bottle contains absolutely nothing!".
Or, at least you hope it contains nothing—
who knows what’s actually in those capsules.
They tested every black raspberry product they could find,
and even ones with the right picture on the front
and powder that actually looked real,
yet more than a third appeared to have
no black raspberry fruit at all.
At the moment, a consumer who assumes
the US dietary supplement marketplace is free from risk
or even honest is unfortunately naive.
How widespread is this deception?
Researchers used DNA fingerprinting techniques
to test the authenticity of 44 herbal supplements
from a dozen different companies.
Less than half of the supplements were authentic,
containing what they said they did.
Most contained plants not listed on the label,
substitutions with cheaper plants,
contaminants, unlisted fillers, or apparently all filler.
And this isn’t just fraud;
some of this deception can really hurt people.
For example, one St. John’s wort supplement
had no St. John’s wort at all,
but actually contained Senna instead,
which is an herbal laxative
that can cause adverse effects,
such as chronic diarrhea, liver damage, skin breakdown, and blistering.
Until dietary supplements in the U.S. are better regulated
and quality control standards are defined and endorsed,
the safer source of phytonutrients
as a consumer is from actual food.
We would love it if you could share with us your stories
about reinventing your health through evidence-based nutrition.
Go to nutritionfacts.org/testimonials.
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To see any graphs, charts, graphics, images, or studies mentioned here,
please go to the Nutrition Facts Podcast landing page.
There you’ll find all the detailed information you need –
plus, links to all of the sources we cite to each of these topics.
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