March 24, 2014

Dietary supplements: myth vs reality (updated to included actual diet types)

If dietary supplements cause as much as 20 percent of severe liver damage cases in the US, why do people keep taking them?

Good question. 

It relates to the myths of the supplement industry vs. those of traditional "western" medicine, especially the pharmaceutical business.

Myth/reality No. 1: Big Pharma is big business. Yeah, and so is Big Supplements. Indeed, so big of a business that we are led to ...

This reality:
Americans spend an estimated $32 billion on dietary supplements every year, attracted by unproven claims that various pills and powders will help them lose weight, build muscle and fight off everything from colds to chronic illnesses.

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That ain't chicken scratch. And, so, because these $32 billion of claims are unproven, we're led to ...

Myth/reality No. 2: Big Pharma is poorly regulated. Big Supplements is even more poorly regulated, and officially so by federal law that officially prevents tighter regulation. Add to that the fact that for supplement diehards, many of your products are made in China, the same country where food factories put melamine in dog food and human infant formula, and that 20 percent of severe liver damage may just be the tip of a supplements damage iceberg.

The reality?
(A)  federal law enacted in 1994, the Dietary Supplement Health and Education Act, prevents the Food and Drug Administration from approving or evaluating most supplements before they are sold. Usually the agency must wait until consumers are harmed before officials can remove products from stores.

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And, Big Supplements is big enough, and aggressive enough, to make sure that that supplements law is currently safe from tightening, or even from being fully enforced with the few teeth it has.

Thus, this further reality:
The FDA estimates that 70 percent of dietary supplement companies are not following basic quality control standards that would help prevent adulteration of their products. Of about 55,000 supplements that are sold in the United States, only 170 - about 0.3 percent - have been studied closely enough to determine their common side effects, said Dr. Paul A. Offit, the chief of infectious diseases at the Children’s Hospital of Philadelphia and an expert on dietary supplements. 
And, because the way the 1994 law is written, all the FDA can do is "estimate."

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Myth/reality No. 3: If there is any harm from bad supplements, or misuse of them, it's only to me. Well, no, not if you're an anti-vaxxer who thinks supplements are the answer to measles or whatever. If you think Supplement X prevents you from Illness Y, and said illness is readily transmittable, and you have other options that would do better against that illness, then you're hurting others.

Beyond myth vs. reality, Americans have always had a strong strain of the Ptolemy vs Euclid issue: The desire for, and the belief that they deserve, a royal road to something. (That's despite, or maybe because of, other Americans preaching the myth of the Calvinist work ethic.)

Result? This:
While many patients recover once they stop taking the supplements and receive treatment, a few require liver transplants or die because of liver failure. Naive teenagers are not the only consumers at risk, the researchers said. Many are middle-aged women who turn to dietary supplements that promise to burn fat or speed up weight loss.
That said, there are naive, or similar, teens who get their supplements for muscle building or whatever from dietary drinks, etc.

Now, there are some studies that show that modern Mass Agriculture has produced foodstuffs with less amount of vitamins and minerals per serving than in the past. However, those differences, which are likely at least somewhat valid, aren't so severe as to require megadoses of vitamins and minerals. And, claims such as "stress," re water-soluble vitamins? Our ancestors, trying to escape lions on the savannah, faced stress themselves. On fat-soluble vitamins vis-a-vis cardiovascular disease or other things? Many of the original claims for them have been shot down; taken in megadoses, even low enough to not be directly and acutely toxic, they can still be harmful.

And, that said, vitamins and minerals do have recognized nutritional value. And, they're inexpensive. That's not true of what most people think of when we talk about supplements. In general, they have no recognized value. And, per my Big Supplements phrase, they're as expensive as hell, in many cases. And, no, that's not hyperbole. For depression, for example, SAM-e can definitely cost more than a generic version of an old tricyclic antidepressant, and possibly more than a generic SSRI. Beyond that, what I said above? The claim of Big Supplements and their touters that any supplement offers a royal road to health, overcoming an illness or syndrome, etc.? It's a lie.

Meanwhile, let's not forget the myths about certain types of diets, above all, the "paleo diet." Dr. David Katz says that no specific diet is perfect, but that Michael Pollan's ideas are a great general guide. In other words, a high-carb diet is fine, as long as it's not processed, i.e, white flour and white rice and white flour noodles. Whole-wheat bread, brown rice, and whole wheat pasta, plus no canned veggies (way too much sodium), other canned or processed foods (sodium and sugar), and you'll be fine. The Mediterranean diet, as long as one uses whole-wheat pasta, is a good approximation.

As for the paleo diet, well, Katz notes that modern meat not only isn't an ancient mammoth, but it's "refined" with a grain diet (oops, how many paleos miss that) plus an overload of antibiotics and growth hormones. Plus, some meats are themselves "refined," like meats that are preserved with salt, sugar, or both (not to mention nitrates, etc.).

Paleo fail.

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