Health vs. Hype / Many `natural' supplements don't live up to their billing
The San Francisco Chronicle
Date: 07/13/1998
It's hard to argue with Pedro Lima. As a staff trainer at San Francisco's World Gym, Lima routinely spends 14-hour days doling out expert advice on how to get in good shape. He also is one of the more sculpted guinea pigs in what some scientists call the biggest uncontrolled medical experiment in history -- America's love affair with diet supplements.
There's foul-tasting echinacea for colds, inexpensive St. John's wort for depression, effervescent growth-hormone releasers for fighting old age, and good old garlic -- now in convenient pill form -- for just about everything.
Lima, 30, swills power shakes spiked with muscle-fueling creatine for breakfast. He is convinced that's one reason his biceps seem to explode out of his tank top.
"It works for me," he said. "Good food is best. But after a while, you reach a point where you don't go anywhere. That's why you need the creatine."
All told, surveys show that about half the adult population in the United States consumes some form of dietary supplement at least once in a while, including vitamins, minerals, botanicals and synthetics. About 20 to 40 percent are regular users.
That consumption generated an estimated $11.8 billion in sales last year, according to Nutrition Business Journal, a trade magazine.
"It just blows my mind," said David Pearson, a nutrition researcher at Ball State University's Human Performance Lab. "People are always looking for the magic bullet."
Of course, there are no magic bullets despite what the marketers - - or your next-door neighbor -- might say. Yet even some skeptics say certain supplements can be worthwhile.
Michael Leff, editor of Consumer Reports on Health, a publication of nonprofit Consumers Union, said the key elements to look for are documented benefits, good evidence of safety, reasonable price and insufficient quantities in a healthy diet.
Otherwise, he said, "you probably don't need it."
Word of mouth is the most oft-cited source of information about what works and what doesn't. It's also the least reliable.
"I have friends and relatives who swear by a lot of things," Leff noted. "I just nod my head and try to keep quiet."
Many so-called natural substances are at best useless, other than as expensive placebos that work only through power of suggestion in true believers. Worse, some supplements can be dangerous.
Regulators moved last year to restrict supplements containing ephedrine and related alkaloids that can have effects similar to amphetamine. Although derived from plants whose medicinal use dates back to ancient times in China, the U.S. Food and Drug Administration said ephedrine-containing supplements were linked to hundreds of illnesses and multiple deaths.
Outlandish claims abound on the Internet and online services. Watch out for come-ons loaded with buzzwords like "breakthrough" and "miracle cure."
All-capital-letters and multiple exclamation points also seem to be standard ammunition.
One recent example touted a combination of ground-up shellfish skeletons and a brew of various amino acids as a "nutritional breakthrough program" for losing weight.
E-mail spam distributed by the Memphis-based marketers claimed that users could lose up to 20 pounds per month and keep it off, with no diet and no willpower required.
The Federal Trade Commission found nothing to back up the claims except bogus "scientific studies" and "consumer" testimonials from people who turned out to be the product's distributors and their spouses. A formal FTC complaint against the company led to a recent consent-decree settlement in which the company agreed to stop misrepresenting the health benefits of its products.
If the enforcement action was meant to scare other supplement peddlers, it clearly didn't work. Last week, one Web-based supplement marketer was offering magic weight-loss pills. Another promised stuff that it says solves impotence problems. A Canadian-based site pushed a single cure for many scalp problems, including hair loss, baldness, eliminating dandruff, pellagra, and dry and greasy seborrhea.
Finding your way through the seemingly unending hype is no easy task.
While there are some valid claims hidden among all this, it's really difficult for the consumer to know what to believe. "The vast majority are based on inadequate science, so nobody knows if they're valid or not," Leff said.
EXPLOSION OF RESEARCH
Despite all the junk, mainstream medical practitioners say they can no longer ignore the fact that people are going to try things whether or not doctors think they should.
As a result, there's been an explosion of serious research on supplements and, for the first time, some convincing evidence that a few things just might work.
There's growing evidence, for example, that Vitamin E and other anti-oxidants might help protect against heart disease, though the American Heart Association said there's insufficient data to justify an endorsement.
Despite the lack of conclusive proof, numerous studies suggest benefits from anti-oxidants without hint of harm. Vitamin E also is cheap and not readily available in a healthful diet, particularly if you are simultaneously trying to cut down on some Vitamin E-rich oils.
In most cases, there's little or no need to take a supplement if you eat the right foods. Still, experts see a place for some supplements, with Vitamin E serving as a good example.
You can get it by eating lots of nuts and seeds, and it's also found in plant oils and mayonnaise. It also can be found in spinach, kale and other leafy green vegetables. Trouble is, the amounts are so small that it just doesn't add up to the recommended daily intake.
"It is really challenging to get that much Vitamin E on a low-fat diet," said Lisa Kelly, a dietitian at the International Food Information Council in Washington, D.C.
STUDIES OF ST. JOHN'S WORT
Known as "nature's Prozac," St. John's wort has been found effective in combating mild to moderate depression. But the only studies so far have been short-term, covering a few weeks of use.
There's still no clear evidence of its effect from months or years of daily dosing. The first large-scale trial in the United States, a three-year study being overseen by the National Institutes of Health, is just getting under way.
Another important caveat is that potency and purity can vary widely depending on the manufacturer. Studies done so far have used varying doses.
The new NIH research effort "will be the first rigorous clinical trial of the herb that will be large enough and long enough to fully assess whether it produces a therapeutic effect," said Steven Hyman, director of the National Institute of Mental Health.
TAKING ECHINACEA
Just about everybody, it seems, keeps some echinacea on hand these days when cold symptoms start to come on. "Personally, I think it's worthless," said Dr. John Renner, an Independence, Mo., physician and president of the National Council for Reliable Health Information.
The active ingredient in echinacea may help mobilize one type of infection-fighting white blood cell. But that's just one of 15 or so basic parts of the immune system, and it's unclear what good it does in reducing cold symptoms.
Many past studies showing echinacea's effectiveness have been challenged by mainstream researchers as technically flawed. There's still no clear evidence that the herb works, Renner noted.
"An awful lot of people taking echinacea aren't doing a thing for themselves," Renner said.
Another recent study showed that zinc lozenges were useless in warding off colds in children. Sponsored by Quigley Corp., a Pennsylvania manufacturer of zinc lozenges, researchers enrolled 249 suburban Cleveland students in grades one through 12. Half began taking zinc lozenges within 24 hours of developing a cold, while half took placebos.
Cold symptoms and duration of illness were the same in both groups. But the lead researcher said the problem may have been that dosages were too low, or even that the flavoring in the lozenges somehow deactivated the zinc.
And now the manufacturer is challenging the results, saying 83 of the youngsters should have been disqualified for various reasons. "The data that resulted from the study provides no meaningful conclusion," the company said.
THE RISK-BENEFIT RATIO
Some supplement-backers maintain that lack of conclusive studies is a bugaboo foisted by the medical establishment in order to keep alternative approaches from gaining currency.
At the Los Gatos Longevity Institute, Dr. Philip Miller treats symptoms of aging with a so-called growth-hormone releaser.
"The theory is that as we get older the output of growth hormone slacks off, but it's still there. Apparently, it can be stimulated to put out a lot more than it does," he said. "The clinical benefits are a combination of both subjective and objective factors. Most of my patients feel better. They get an increased sense of well-being. Many report an increase in strength and endurance."
If it sounds too good to be true, it probably is. The supplement product that Miller uses, called Symbiotropin, has not been linked to safety concerns associated with direct dosing with the growth hormone itself, but Miller conceded that he can't cite scientifically persuasive evidence that it works.
Echoing a widespread view among practitioners of alternative medicine, he said that's not going to stop him from doing what works at least from his own observations.
"There are a lot of things done in medicine that are not backed up by good studies and good research, and they are done all the time," he said. "For a long time, we didn't know how aspirin worked. You have to look at risk-benefit ratios and determine whether the long- term benefit outweigh the risks. People want zero risk, but that's not going to happen."
THE CREATINE CRAZE
A similar philosophy seems to be fueling the current creatine fad sweeping the world of sports and bodybuilding.
Beyond the muscular examples plying your local health club, some of the biggest names in pro sports apparently agree that creatine is as essential as weight-training.
Although precise numbers are unknown, Sports Illustrated reports anecdotal evidence -- including tubs of creatine powder sitting in the locker room of the Los Angeles Lakers and personal testimonials by the likes of St. Louis slugger Mark McGwire -- that about a quarter of big-league basketball and baseball players swallow the stuff.
"Among athletes, creatine is by far the most popular supplement out there," said Heidi Skolnik, owner of Nutrition Conditioning Inc. in New York and a nutritionist advising the New York Mets, New York Giants and The School of American Ballet.
"A lot of professional athletes are taking it, and a lot of people who aren't professional athletes are taking it, too," she added. "It's legal. It has not been banned. So there's no legal reason they shouldn't be taking it. . . . People are always looking for an edge."
Naturally synthesized from amino acids in the liver, pancreas and kidneys, creatine is an important nutrient found in all meat products. It helps supply a ready source of energy to certain muscle fibers.
A new study by Pearson linked creatine supplementation to statistically significant gains in strength measures and lean body mass. He compared varsity football players taking a moderate dose of 5 milligrams of creatine daily for 10 weeks with players taking a placebo.
Even some of the most prominent skeptics say there's convincing evidence that creatine really works. Strength gains of 5 percent or more have been widely reported by some of the world's star athletes.
"There are some studies that show in a highly trained athlete, creatine can give an extra boost for a short period of time," Renner said.
But nobody knows what the long-term consequences of daily creatine supplementation might be. Some doctors fear that excess doses may damage the heart muscle over time, and there are unproven links to muscle pulls and cramps.
And then there's the expense: A recommended regimen of creatine may cost you $30 or more a month. That's no problem for pro athletes, who also can afford superb medical care to make sure nothing goes wrong, but it's a different story for those who try to follow the examples set by the superstars.
"It's all the high school athletes who are going to have trouble," Renner said, calling creatine supplementation a potentially dangerous form of "blood doping" that he believes should be banned from competitions.
For ordinary people and even weekend-warrior athletes, there's no reason at all to use creatine, said Katharine Grunewald, a Kansas State University professor who has studied diet supplements.
"It helps in generating sudden bursts of energy in peak-performing athletes," she said. "It would have no benefit to anyone else."
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FIFTH FOOD GROUP -- COMMON SENSE
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It's easy to get lost in the bewildering profusion of health- promoting diet supplements. But medical experts say common sense and a few guiding principles can get you through safely:
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-- There's no substitute for proper nutrition and exercise.
In nearly all cases, supplements aren't necessary if you stick to a healthful, varied diet. And don't smoke.
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-- Seek advice from a health professional you trust.
Chances are your doctor knows more about so-called alternative medicine than you might suspect. If you can't get straight answers, get another doctor.
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-- Don't bet your health on advice from friends and neighbors.
Just because someone says a supplement works for them doesn't mean it will for you. In many cases, useless herbs and "natural" medicines are just expensive placebos that only help those who believe. And while most may be harmless, there's no guarantee that long-term use is safe.
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-- Distrust claims from commercial interests.
Unlike prescription drugmakers, who must spend years in clinical tests before they can market their products, supplement manufacturers don't need hard proof to market their wares. Outright fabrication is not allowed and health-related claims are supposed to be general in nature, but it's often difficult to tell if the rules do much good.
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-- Supportive evidence may not be all it seems.
"Studies" often are biased, poorly designed or too small or short- term to be conclusive. And promoters may not be sharing results that go against their interests.
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-- Do some research.
Consumers Union publishes an excellent resource, "Consumer Reports on Health," a monthly newsletter that includes regular features on popular diet supplements. Subscriptions run $24 a year (800) 234- 2188.
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-- Use the Internet -- but beware.
Most commercial sites are biased in favor of selling you something. If you simply do a search on one of the standard Web browsers for whatever supplement interests you, be prepared for a deluge of advertising.
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Here are a few reputable places to check for solid information:
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-- altmed.od.nih.gov Gets you to the National Institutes of Health's Office of Alternative Medicine, which offers technical discussions and other resources on most popular supplements.
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-- www.ncahf.org Takes you to the National Council for Reliable Health Information, formerly known as the National Council Against Health Fraud. Quack-busting physicians poke holes in the latest supplement fads and offer straight advice to consumers as well as professionals. The site includes a search engine and resource list.
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-- www.medscape.com One of the more prominent medical-related online services. It is geared toward practitioners but general enough to be useful to a motivated consumer. Registration is free. The site offers convenient access to most standard medical references and news sources.
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-- dietary-supplements.info.nih.gov A new site that opened last week by the Office of Dietary Supplements, a branch of the NIH established in 1995. The site includes convenient searching for government-sponsored research and schedules of conferences and other supplement-related health topics.
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-- Dr. Andrew Weil's "Self-Healing." Issued monthly, $29 a year, Thorne Communications, Watertown, Ma., (617) 926-0200.
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-- Carl T. Hall -------------------------------------------------- ------------------
CHART:
TAKE SOME FACTS WITH YOUR SUPPLEMENTS
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Despite their widespread popularity, most diet supplements have no proven benefit, cost a lot of money and sometimes do you more harm than good. Here's a look at a few of the most popular supplements:
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Supplement / Claim / Evidence / Cautions
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-- Creatine
-- Builds muscle, boosts energy
-- Mixed. Some short-term studies show benefits in peak athletic performance.
-- No evidence of long-term effects.
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-- St. Johns Wort
-- Antidepressant, "Nature's Prozac"
-- Limited. A recent review of 23 small studies in Europe showed benefit in mild and moderate cases of depression.
-- First large-scale trial in U.S. just getting started.
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-- Echinacea
-- Fights colds, infections
-- A few controlled trials in humans show increases in immune function -- Benefits wane after continued use. No proven health benefit. ------------------------------------------------------
-- Growth hormone
-- Slows aging, boosts energy
-- None. Anecdotal reports suggest some users are reinvigorated. - - Possible hazards from long-term use. .
Source: Chronicle research, Consumers Union "Consumer Reports on Health," National Council for Reliable Health Information.
(Copyright 1998) |
