Tag Archive for: dietary supplements

Teaching Doctors About Supplements, But Not Really

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If you haven’t watched the videos that I talked about Tuesday, please take the time to watch them, preferably before you continue reading—I’d like you to form your own opinion about the videos before you get my perspective. I came away with three opinions about the videos, other than they really focused on dietary supplements not being approved by the FDA. Of course, no legitimate healthcare professional or supplement manufacturer ever said they were; consumers may not know that, but I would hope doctors did.

First, the second video discussed potential drug-supplement interactions. There have been few direct studies on those interactions; most are case studies involving the use of herbs such as St. John’s wort and ginkgo biloba that have been published in peer-reviewed journals. What they don’t say is that very few studies have examined drug-drug interactions either. How do they find out about them? Trial and error from reports to the FDA’s adverse effects reporting system.

That addresses my second opinion. There was a strong focus on reporting adverse events from dietary supplements to the FDA. One would think that’s a good thing, but the list of adverse events they listed included every system in the body. I get reporting an allergic reaction, but how would a physician attribute gastrointestinal or cardiovascular issues to a dietary supplement after putting the person on a new medication? It’s just as likely to be due to the medication. Seems to me like an open door to lots of irrelevant reports.

Finally, they spoke about some supplements interacting with blood tests. The only one I’m aware of is excessive biotin intake affecting the troponin test for potential cardiac events. One would expect an extensive list would be provided; the problem is none exists because that’s the only known interaction.

The Bottom Line

There are 13 vitamins. There are dozens of minerals, most found in trace amounts. There are hundreds of herbs, plus nutrients that don’t fall into any of those categories. All can be found in dietary supplements. If I were a physician who spent time watching the videos, I really wouldn’t know more about those nutrients in supplements than I did before I watched. I would have learned only two things:

  • The FDA does not have the authority to approve dietary supplements.
  • If a patient takes dietary supplements, anything bad that happens in the body should be reported as an adverse event.

A lot of red flags were waved when the issues deserved a yellow flag at most. I can think of only one word: sad. With the lack of training and knowledge about supplements among doctors, I think those two organizations could have spent their money better and created videos that would have really helped doctors and their patients.

What are you prepared to do today?

        Dr. Chet

References:
1. https://www.youtube.com/watch?v=GYJYPCJmspE
2. https://www.youtube.com/watch?v=qqyP-vbtlZY

Teaching Doctors About Supplements

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In late May, the Food and Drug Administration (FDA) in partnership with the American Medical Association (AMA) released two short videos to teach physicians about dietary supplements, plus a third aimed at consumers.

The first video spent time defining and explaining what a dietary supplement is, the delivery systems companies use such as tablets,  gummies, bars, etc., and the role the FDA plays in the process. The second video focused on adverse events, how to report them, and a sample conversation between a doctor and patient. I encourage you to watch the videos at the links below.

I think there are two important points of the videos. First, the FDA does not approve dietary supplements in the same way that they approve pharmaceuticals—obviously their main point because it was repeated several times. In exchange for allowing supplements to be introduced quickly, companies do not have to prove safety or effectiveness. However, if they make any health claim, they must report that to the FDA within 30 days of making the claim. Those claims are restrictive; a company can’t say on the bottle or promotional materials “cures heart disease” but can say “contributes to a healthy heart.”

Second, you should always discuss the supplements you take with your physician, especially if you take medications. It can be a pain if you take a lot of supplements, but you must do it because there can be interactions. For example, calcium, whether from food or a supplement, interferes with the absorption of thyroid medications. They should not be taken together (which is tricky because it’s recommended thyroid meds be taken at bedtime when you may be taking a calcium-magnesium supplement to aid sleep).

Those are what I see as the positives of these videos that cover supplement companies and patients; there’s no information about how supplements work or which supplements do what. I’ll cover that aspect of the videos on Saturday. In the meantime, take the time to watch both 10-minute videos.

What are you prepared to do today?

        Dr. Chet

References:
1. https://www.youtube.com/watch?v=GYJYPCJmspE
2. https://www.youtube.com/watch?v=qqyP-vbtlZY

Sorry, but Some Health Writers are Scammers

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The typical research paper may have findings that are controversial, but researchers are using the techniques of their profession. I may disagree with their conclusions for a variety of reasons, but at least it’s contained. Following the threads this author created was a challenge but fruitful, especially the first one.

The readers of her columns were told to hop on over to the FDA website to see how easy it is to get beneficial statements on the label. I read the entire set of guidelines, and here’s the bottom line: it’s most definitely not easy to get a label claim approved.

She asked the industry rep to give her the name of a scientist who is not in the supplement industry who believed the health claims on supplement labels were meaningful. The rep couldn’t think of anyone.

She made a big deal over that one: no independent scientist supports the claims on labels. “Just think about what that means,” she added. It means that the supplement industry rep isn’t acquainted with scientists outside of her area of expertise. Why would she be? It’s not her area. But if you’ve been a science writer for over 22 years, you would certainly know plenty of scientists. Why didn’t she contact them for their opinion?

The writer then talked about a conversation with an executive for a well-known nutrition watch-dog group. He talked about the gold standard for removing a product from the marketplace: ephedra was banned back in 2003 because people who took the weight loss product had died.

Actually, it took the death of a professional football player to get everyone interested in ephedra, which is more like medicine than a supplement. People died, but in most of those 55 cases, it was the abuse of the herb that caused the issue, not the recommended use. I wasn’t an ephedra fan because weight loss is calories in, calories out; you would expect that messing with metabolism to cause issues, especially when overusing an herb.

Then it was a wandering rehash of other studies on increased risks of cancer. It was her responsibility to do the reading before she wrote the article. Was she being one-sided in what she wrote? I think a better way to say it was that she didn’t complete her background research.

There was some talk, silly in my opinion, with a religion professor about the psychology of why people take supplements. And then she completed her comments by saying that people who take dietary supplements are wasting money on products that will never help them.

The Bottom Line

All in all, it was a poorly researched article about the benefit, or lack thereof, of dietary supplements. What was clearly apparent was that her lack of nutrition education meant she really didn’t know what questions to ask. Based on what she said, she never really read the FDA Guidelines for supplement manufacturers. If she had, she could have picked a product with a wild claim, and I can think of several, checked the background research, and then evaluated it according to the law to determine whether it complied or not, rather than simply saying it was easy.

Health writers, and in fact, any writer who writes about science, needs to be a critical thinker, not one that criticizes without thinking. In this case, she failed to do her job. The big problem with that is most people don’t have the science background to know whether what she said is trustworthy and many people will be misinformed, perhaps to the detriment of their health.

What about her claim that people are wasting money on supplements? We all know from our own experience, as well as from science, that supplements can make a difference in our health. As I’ve always said, no amount of supplements will make up for an unhealthy lifestyle, but using specific supplements are an important part of staying healthy.

What are you prepared to do today?

        Dr. Chet

Reference: FDA Link: https://bit.ly/2QLDRa2

Investigating Supplements

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Let’s turn to what the author I wrote about on Tuesday said and examine it in detail. She interviewed a variety of experts; I checked them out and they were most definitely legit, especially those who worked in the research arms of the NIH. She asked them a simple question that went something like “Which supplements have well-established benefits?” The scientist who works in the complementary and natural approaches research arm said the list was short: ginger for digestive issues, peppermint for the same, melatonin for sleep, and fish oil for cardiovascular disease all have established benefits. The clinical trials that weren’t as beneficial were for turmeric, St. John’s wort, ginkgo biloba, and echinacea. (That doesn’t mean they won’t work for you; we’re all different.)

Then she talked with an expert in vitamins and minerals who recommended folic acid for neural tube defects, vitamin B12 for vegans and the elderly, the combination of nutrients that seems to help with an eye condition and finally, that multivitamins have some benefit.

She then asked the same question of a senior representative of a dietary supplement industry group. The person replied with much the same list of supplements and benefits.

In effect, the government agencies and the industry group agreed about benefits from some supplements. The next logical question in the writer’s mind was “What about all those supplements that neither group addressed? What about those supplements that fill the shelves of pharmacies, health food stores, and on the Internet? The type that say ‘good for energy,’ ‘may help your immune system,’ and so on.”

The author suggested that a curious person should just bop on over to the FDA website to see how easy it is for companies to get these statements on the product labels. So I did. I’ll let you know what I found out and finish this on Saturday.

What are you prepared to do today?

        Dr. Chet

Don’t Fall for a Bad Headline

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The headline of the Life and Culture section of my local newspaper was this: “Supplements Are a Scam.” You know that has to get my attention. Wouldn’t it get yours? Most of us take dietary supplements every day, so I read the article.

To paraphrase the opening, it went something like this “Wake up people! There are conspiracies about vaccinations and fluoridation floating around the internet. Why aren’t you pulling back the curtain to see the fraud right under your nose! They are selling you snake oil and you’re giving them a free pass. Who? The supplement industry, of course.”

The article contained some of the same-old, same-old arguments that we always see in these articles; more about that later. The question I always begin with is: “Who is doing the writing and how qualified are they?” This author has been writing about health for major newspapers and magazines for over 20 years. If she’s lasted that long, she must be a decent writer.

But does she have a solid background in science and nutrition? She got her undergraduate degree in English. That’s it. I’m not trying to be snooty, but that puts her into the category of someone who is self-taught. Whether it’s a person who was on death’s door but recovered when they discovered a supplement or diet that helped them or someone who’s a journalist as the author is, they need solid basic science and nutrition education and training. If not, they don’t know if they are asking the right questions, and that’s often a problem when it comes to nutrition research. As I’ve stated many times before, even those who do have health training often don’t ask the right questions but have no problems sharing opinions.

Are supplements a scam? Short answer: no. We’ll look at the claims the author made on Thursday.

What are you prepared to do today?

        Dr. Chet