May 2017

On Vitamins and Dietary Supplements

Last year the Institute of Internal Medicine came out with a report that said you can save your money on daily multivitamins as they do not work to prevent morbidity or mortality; since then I have noticed an enormous increase in 1V commercials for multivitamins. There is so much money in unproven dietary supplements that the industry was able to successfully lobby for an exemption from Federal Drug Administration (FDA) regulation. In 1994 Congress passed the Dietary Supplement Health and Education Act sponsored, and protected since then, by Senators Orrin Hatch (Utah) and Tom Harkins (Iowa). Under the law the FDA can only pull a supplement off the market if it can be proven dangerous, and it can only comment on a supplement if the manufacturer makes unsubstantiated medical claims. So for example, in 2012 the FDA sent a warning letter to Quincy Bioscience the makers of Prevagen asking the company to desist from making unproven claims that its jellyfish drug helps improve memory and staves off dementia. The company refused to do so, and went on to secure contracts with most major pharmacies while advertising the product on television. Most people think that a product advertised on 1V and sold by their friendly pharmacist cannot be bad, so this scam has been going on for years. The only ray of hope is that the Federal Trade Commission filed suit against Quincy for fraud in February of 2017. The company replied by saying that it was confident that the suit would be withdrawn by the Trump Administration; this is not just idle posturing as the industry has real power.

It gets worse. Ephedra (rna huang) the dietary supplement that supposedly helped with weight loss and athletic performance had to kill at least 155 people. Including Baltimore Orioles pitcher Steve Bechler, before the FDA was able to move against it in 2004; even then a federal court overturned the decision before the Court of Appeals in 2006 agreed with the FDA that the evidence was overwhelming that it caused seizures, strokes and heart attacks. Since then only a handful of people have died from the now illegal use of the drug.

Even worse is the fact that we do not know what is in the bottle. The PBS documentary Frontline broadcast a show on January 16, 2016 in which a wide range of vitamins and dietary supplements were studied to see if the contents of the bottle matched the label. Over 70% of the products chemically analyzed were found to have false labeling. This is hardly surprising as nobody is regulating the industry. Many if not most people assume that anything labeled "natural" must be good and cannot cause harm; but almost all modern drugs are derived from nature. Aspirin is processed from the bark of the willow tree; yet it can do both good and harm and so must be used appropriately and carefully.

Most dietary supplements are not well studied, so we do not know if they work. Or for whom they work; and we do not know their side effects, drug interactions and harms. You take them at your own risk.