Last week, the New York State Attorney General's office unveiled what could potentially amount to fraud in the dietary supplement industry. The office targeted four major retailers of supplements, Target, GNC, Walgreens, and Walmart, and accused them of selling bogus supplements. The office backed their claim that the retailers were selling supplements that contained very little, or none at all, of the advertised ingredients and demanded that the supplements be removed from their shelves as they could potentially cause harm.
This revelation, if true, is a real blow to the supplement industry but more so to consumers who have had their faith in the benefit and safety of the supplements they take shaken. However, I recommend that you don't throw out all of your supplements just yet. It has surfaced that the claims made by the attorney general's office relied upon DNA testing as the primary means for identifying the ingredients contained in the supplements tested. This matters, because while DNA analysis is appropriate in certain applications, this methodology has not been validated for identifying botanical materials in herbal extracts.
Here is the issue with DNA testing of botanical/herbal ingredients in a nutshell: Most botanicals/herbals are concentrated extracts and depending on how they are extracted, there may be no DNA present. The best approach is to take each ingredient and evaluate the best test method based on its concentration or extraction method and work with the testing lab and ingredient supplier. What this means with regards to the case in New York, is that the products pulled from the shelves were tested using an inferior testing method so we do not know if they in fact truly failed anything with regards to identity testing. A more significant concern was that some supplements labeled gluten-free were found to contain wheat and other potential allergens not listed on the label.
Identity testing is a requirement of dietary supplement good manufacturing processes, or GMPs, so it is the expectation that all ingredients going into a dietary supplement products should be properly identified by the manufacturer of a given supplement. In fact, it's the law. Clearly, we know that not all companies are meeting the GMP requirements and industry standards at this time, but the law is sufficient to regulate supplement companies, it just needs adequate enforcement by the authorities.
Supplement production is actually regulated in the sense that there are legal standards that must be upheld. However, not all companies honor them. FDA Good Manufacturing Practices (cGMPs) mandates:
- Proper quality controls to ensure that consumers have access to accurately labeled and unadulterated dietary supplement products.
- At least one appropriate testing procedure to verify the identity of all ingredients used in dietary supplements, including botanical ingredients, and to document the testing methods used to verify identity.
- Established specifications for the purity, strength, and composition of dietary supplement products, including limits and controls for potential contaminants.
- That tests used to determine whether quality specifications are met are based on appropriate and scientifically valid methods.
As a doctor, when I have a patient literally dump a bag of supplements on my desk, I examine each and every one. I ask, "Why did you start it? Has it helped?" Many times people will mention that they noticed this symptom or that, and found an article online pointing them to the supplement they eventually began to take. Other times they start a supplement on the recommendation of friends and family and sometimes they start it under the recommendation of a physician.
Supplements Done Right
It's understandable why you would may have a cabinet full of supplements at home. Supplements are highly marketed as providing benefits that we want, such as more energy, digestive health, healthy immune function, balanced mood, and the list goes on. For many people, these complaints and declines in their well-being are not perceived as severe enough to seek out medical care, so taking a supplement fits the bill instead.
The right supplements can provide a benefit, when properly matched to your unique needs. My practice specializes in nutrition and metabolism with an emphasis on helping people lose weight and correct insulin resistance. In my medical practice, I run simple blood work on all of my patients for three common vitamin and mineral levels. Time after time, these three are revealed to be deficient:
- Vitamin D -- With a practice in Florida, many would assume that my patient's levels of vitamin D (which is made in our skin from the sun) would be high, however it is very often low, especially in those with insulin resistance.
- Vitamin B12 -- Vitamin B12 is important for energy and often comes up low as well in my patients' results. Many are on stomach acid blocking medications which are known to impair the absorption of vitamin B12 and many were unaware of this medication's side effect.
- Magnesium -- Magnesium is a very important mineral that is needed in over 300 enzymatic reactions. Magnesium is much less present in our food supply than it was 50 years ago due to current farming practices. A patient of mine, who is a commercial tomato farmer, confirmed that magnesium was not a mineral that is required to be returned to the soil. Calcium also competes with the absorption of magnesium so people with high calcium diets or on calcium supplements can end up with a magnesium deficiency. When people have low magnesium and it is corrected with a quality supplement, there is a great improvement in quality of life. Symptoms of low magnesium include constipation, leg cramps, tight muscles, palpitations, headaches and anxiety among others. These are very often symptoms that people attribute to aging or stress.
If I have patients experiencing hair loss, skin changes, various gastrointestinal concerns or even memory issues, I recommend a high level vitamin profile to determine if one or more vitamins, minerals or amino acids are deficient. Identifying and correcting deficiencies has been one of the most rewarding things I have done in my twenty four years of practicing medicine. This corrects a root cause as opposed to prescribing laxatives, muscle relaxants, anti-depressants or other medications to treat the symptoms of the deficiency.
In medical school, I was taught about enzymes and cofactors and that vitamin and minerals were important. However, the prevailing thought was that if you eat a healthy diet, you will not need supplements and only those who have bizarre eating patterns will be at risk for deficiencies. In my years of clinical practice, I have found evidence of deficiencies even in those with a very healthy diet. Further testing revealed individual biochemical differences in absorption, metabolism and bio-availability of nutrients which was further supported by analysis of the patient's genes. Some people will always need a higher dose of specific vitamins and minerals than others due to their unique chemistry. In addition, the best diet may not be able to safeguard against deficiencies induced by medications.
However, very importantly, I would not recommend these supplements without prior blood work:
- Vitamin D in doses of higher than 2000 IU if you do not know your level. Vitamin D is a fat-soluble vitamin and levels can build up. I have had patients come in taking 10,000 IU of vitamin D per day with no medical supervision and have had excessive levels of vitamin D in the blood.
- Magnesium if you have kidney disease unless you are being closely monitored by your physician and he or she is aware you are taking magnesium.
So you can see that two of the most common vitamin and mineral deficiencies I find in my patients correspond to the two supplements that I suggest the general public avoid without having blood work to support the need to take them. This goes to show that the advice that you read in a newspaper or magazine is not necessarily applicable to you, and that a one size fits all approach to supplements is has the potential to cause you more harm than good.
What about herbal supplements?
Over my years in medical practice, I have become quite comfortable with using certain herbal supplements. Insulin resistance, mentioned earlier, is a metabolic condition that makes gaining weight easy and losing weight challenging. This condition improves with the right dietary and lifestyle interventions but sometimes it is not enough. The addition of medication is an option, but many of my patients want to avoid taking more medicines. I studied the literature extensively and found that certain natural substances and herbs like cinnamon, alpha lipoic acid, berberine, and resveratrol among others were studied in respected medical journals and found helpful in supporting healthy glucose homestasis -- which is supplement lingo as supplements cannot claim to treat any particular disease or condition.
As a physician, when I recommend an herbal supplement, I am in fact practicing medicine. I need to be aware of all the other medications and supplements my patients are on. I find this aspect of my work to be quite complex. I find it critical that the supplements I recommend contain the correct ingredients in the correct amounts and be free of fillers, binders, contaminants, heavy metals, PCBs, and food allergens. My goal is to help someone be healthier and those additives are certainly a major concern. Several years ago, I found a supplement company that creates supplements for sale through physicians who had the purity platform I was seeking. I went as far as to visit the company, tour the manufacturing plant and see firsthand the plethora of testing and quality control followed and I was impressed. I later became a paid consultant and have collaborated on the science of certain formulas and speak on nutritional medicine for the company.
I find vitamins and herbal supplements to be useful adjuncts to diet and lifestyle interventions in my practice. Numerous studies from peer-reviewed medical journals are published every month and there is quite a lot to keep up on. A study will support the benefit of certain supplements in one type of patient but show harm when the same supplements are taken by another group or people with different medical conditions. The key is to know the difference. By contrast, a customer may speak to a clerk in a vitamin shop who certainly does not have a medical degree nor an in depth understanding of the medical conditions and medications that person is on.
I highly suggest speaking with your doctor before taking any supplements to find companies that follow industry standards and regulations. See this link for other supplements to look out for.
With dietary supplements, it is truly buyer beware. I do not recommend more regulations than already exist but rather that the regulations be followed and enforced. If you do purchase supplements, it is important to choose a company recommended by your health care professional, one that is transparent about their quality and manufacturing methodologies and can ensure they follow the standards of the industry to provide the best ingredients and quality for your health and wellbeing.