Millions of Americans believe that nutritional supplements provide health benefits. They are convinced that the “natural” ingredients in these over-the-counter products (pills, powders, liquids, and gums) can prevent disease, make them feel better, and slow the effects of aging.
Supplement sales in the US will reach $51 billion in 2022, according to a market analysis by Grand View Research. “Consumers are becoming increasingly aware of such products and their benefits through effective marketing campaigns, influencer endorsements and social commerce,” the report noted.
All that marketing is working. More than half of US adults (55 percent) regularly take nutritional supplements, according to a recent survey by the Council for Responsible Eating, an industry trade group. The majority of respondents (74 percent), including those who do not use these products, said they “trust” the dietary supplement industry.
But is this belief warranted? Consumer advocates warn that, in many cases, it is not. They are concerned about the way these products are often marketed and the lack of government oversight to ensure quality, safety and effectiveness.
“Strong evidence to support claims made for dietary supplements is often lacking,” according to the National Center for Complementary and Integrative Health (NCCIH), part of the National Institutes of Health.
The NCCIH points to a 2022 review of 27 ingredients often included in supplements with claims related to immune function, such as “supports a healthy immune system” or “natural immune booster.” Conclusion:
“The reviewers searched the scientific literature for rigorous human studies on the effectiveness of each ingredient and found evidence of this type for only eight of them. Some of the studies suggested possible benefits, but the evidence was not strong enough to allow definite conclusions to be drawn.”
Most supplements are sold without supervision
A new prescription drug cannot be approved for sale until the manufacturer has proven that it is safe and effective. There is no such regulatory standard for supplements.
The Food and Drug Administration (FDA) does not review or approve supplements before sale. In most cases, manufacturers are not even required to notify the FDA when they introduce new products.
“They’re completely unregulated, so people really don’t know what they’re getting when they buy things over the counter,” said Dr. John Swartzberg, head of the editorial board at the UC Berkeley Wellness Letter. “[People] believe that if the label says that this supplement has a certain amount of a certain chemical, they can trust it. You can’t necessarily. They believe that the word natural in supplements means that the product is safe; this is not about safety or efficacy.”
Supplement packages and advertisements are required to include a disclaimer stating that the FDA has not evaluated their products or the claims they make, but most consumers miss the fine print notice or simply ignore it.
But are you getting what is promised? Without pre-market quality testing requirements, supplement manufacturers can claim their products offer a host of benefits without proof. Even if a product is beneficial, a manufacturer may replace an expensive ingredient with a cheaper alternative, or add a banned drug without disclosing it.
The nonprofit Center for Science in the Public Interest (CSPI) warns that weight loss and sports performance supplements have been found to contain “dangerous, banned amphetamine-like stimulants.” Some sexual enhancement supplements include “Viagra-like drugs” and some weight loss supplements have tested positive for the drug sibutramine, an appetite suppressant now banned in the US.
“It is illegal to add any drug—banned or not, dangerous or not—to supplements,” CSPI’s Nutrition Action newsletter noted.
Congress mandated this far-reaching approach when it passed the Dietary Supplement Health and Education Act (DSHEA) in 1994, after intense lobbying by the supplement industry. As a result, the Wellness Letter explains, dietary supplements are “regulated as a class of foods, not drugs,” and therefore, “it is the FDA’s responsibility to prove that supplements are harmful.”
Because of DSHEA, the FDA’s primary role is to investigate when supplements are found to be contaminated or making people sick. And it happens: Each year, about 23,000 emergency room visits in the U.S. “are attributed to adverse events related to dietary supplements,” resulting in about 2,154 hospitalizations, according to a 2015 study published in the New England Journal of Medicine. .
Deceptive Marketing
Congress gave supplement manufacturers a lot of marketing leeway when it passed DSHEA 30 years ago. But there are some limitations. Companies cannot claim that their products prevent, treat or cure a disease, but they can boast that the product “supports” or “maintains” a body structure or function.
For example, a supplement may not claim to “reduce depression” but may promise to “help improve your mood.” And a manufacturer could not claim that its product “prevents colds and flu”, but could promise that it would “support the immune system”.
“Companies are also very good at keeping things vague, but using our psychology with lures for vitality, energy or just being your best self,” said Caitlin Dow, senior nutrition scientist at CSPI. they’re not saying anything, but it’s inspiring, and that’s all they have to say to stay out of the FDA’s eyes and attract consumers.”
These “linguistic loopholes” sell many products, Dow told Checkbook. Most people can’t tell the difference between something that says it “supports joint health” versus “will relieve knee pain,” she said. “They read them [statements] in the same way.”
But some supplement manufacturers cross the line, warned Bonnie Patten, executive director and co-founder of Truth in Advertising, a nonprofit that exposes false advertising and deceptive marketing.
“[They] find it economically beneficial to lie to consumers about what these products can and cannot do,” Patten told Checkbook. “There are a lot of wild and misleading claims being made without any evidence of efficacy about what these products can do. supplements.”
Consumers are really motivated by the magic words “clinically tested” or “clinically proven”. They are more likely to believe the marketing for products that make these claims, “even though it may be that the company doesn’t really have the proper scientific backing to make those claims,” Patten said.
Just because something was tested doesn’t mean it was good science. In many cases, the companies selling the product have paid for the research.
“It’s almost comical how bad the research is on some of them,” Dow said. “It’s not about health, it’s about marketing.”
Some companies fund studies that don’t include a placebo test group, which makes any conclusions meaningless, or they test for something that really doesn’t matter. Another scam: Pay to have the study published in a low-level journal to add credibility to the nebulous claim.
Supplement companies often use fine print to protect themselves from accusations of false advertising. A few years ago, an ad for Leanfire supplements from Force Factor claimed that Leanfire could “double your weight loss.” But CSPI caught the fine print qualifier that appears on the screen for just a few seconds, which read: “Atypical results. A healthy diet and exercise is recommended for optimal results.”
Forget the memory pills
As the country ages and cases of Alzheimer’s disease and other forms of dementia become more common, demand for supplements that promise to boost brain health, improve mental acuity and improve memory has increased.
About one in five (21 percent) American adults 50 and older take a vitamin or dietary supplement for brain health, according to a 2021 study by AARP.
Unfortunately, health experts warn that the marketing claims for these expensive supplements do not match the science.
“Most of the research on these brain health supplements has come up empty despite these promising claims, despite the promising evidence,” CSPI’s Dow said. “There has been some research showing that some memory supplements also contain unapproved drugs, which is illegal. So I’d say pass.”
Shop Smart for Supplements
Some supplements can be helpful when recommended by your doctor and certified for quality. I take vitamin D because blood tests showed my levels were low. Many people take multivitamins every day. This does not guarantee good health, but for us, these types of supplements will do no harm.
But with so little oversight of the supplement market, you have to be careful what you buy and where.
Most quality claims, such as “third-party lab tested” or “made with good manufacturing practices” sound impressive, but are meaningless—and not verified by the FDA.
Health experts recommend looking for one of three quality assurance seals: ConsumerLab, USP (US Pharmacopeia) and NSF (NSF International). You can trust them more because their testing is done by independent organizations that check that the products contain the ingredients on their labels, are free of contaminants and break down quickly enough to enter the bloodstream. However, these products have not been tested to determine whether they provide the promised health benefits.
Keep your doctor in the loop
Your doctors need to know if you take supplements because they can interfere with both prescription and over-the-counter medications, making them more potent (and possibly toxic) or less potent (and therefore ineffective).
For example, here’s what the National Institutes of Health says about two popular supplements:
- St. John’s wort can weaken the effect of many important medications, including antidepressants, birth control pills, warfarin (blood thinners), some statins (including simvastatin), some heart medications (including digoxin), and some HIV medications.
- Ginkgo biloba may interact with some conventional medications, including anticoagulants (blood thinners). It may be “unsafe” to take by mouth during pregnancy.
Some supplements, such as chaparral, comfrey, kava and skullcap, can cause liver damage, especially when taken long-term or in high doses, the FDA warns.
Bottom line: If you’re going to take supplements, make sure your healthcare provider knows. If you have a medical problem, instead of self-medicating with supplements, talk to your doctor. There may be treatments or even dietary measures that can help your condition.
This article was based on Checkbook’s Consumerpedia podcast, episode #66: Cutting Through Nutritional Supplement Ads
More information:
UC Berkeley Wellness Letter:
CSPI Nutrition Action Newsletter:
Truth in Advertising (TINA.org):
Consumers’ Checkbook magazine and Checkbook.org is a non-profit organization with a mission to help consumers get good service and low prices. It does this by providing unbiased reviews, advice and pricing information. Checkbook is supported by consumers and takes no money from the service providers it rates. You can contact Herb at his website ConsumerMan.com.
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