From dietary supplements to the emergency room

If there's one thing I've been consistent about, it's that, however ridiculous all the other woo I routinely discuss here is—homeopathy, reiki, reflexology, I'm talking to you and your friends—herbal medicine and supplements might have value because they might have a physiological effect that is beneficial in treating or preventing disease. Of course, if that's the case, it's because the herb or supplement contains chemicals that act as drugs. They're "dirty" drugs in that they are mixed with all sorts of other substances in the herb or supplement that might or might not have effects, which means that different lots of the herbs or supplements often have different activity, but they are drugs nonetheless. That's why, for instance, doctors don't tell patients to chew on foxglove leaves when they want a patient to get digoxin. Digoxin is a powerful drug with a relatively narrow "therapeutic window," meaning that the difference between the levels of the drug in the blood needed for therapeutic effect are not very far from toxic levels; so predictable, reliable drug content is essential. I just learned a while ago that within the living memory of some older physicians digoxin actually was prescribed as crude extracts, which was very difficult and dangerous, hence the necessity of purification. In other cases, (such as Artemisinin, for which Youyou Tu was recently awarded the Nobel Prize in Physiology or Medicine), crude plant extracts do not contain sufficient quantities of the active component, necessitating its isolation, purification, and, in some cases, chemical modification to increase its absorption, stability, or activity.

One thing that proponents of herbal medicine and supplements often forget, though, is that if herbs or supplements can have potentially beneficial effects (albeit difficult to regulate effects due to the crude, impure nature of the extracts often used) because they contain drugs, then herbs and supplements can also produce adverse events, again, because they contain drugs. You can overdose on herbs and supplements. This point was recently reinforced by a new study by Geller et al published yesterday in the New England Journal of Medicine (NEJM), entitled Emergency Department Visits for Adverse Events Related to Dietary Supplements. It was carried out by investigators from the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, and Chenega Government Consulting; and the Center for Food Safety and Applied Nutrition and the Division of Public Health Informatics and Analytics and the Division of Dietary Supplement Programs, Food and Drug Administration. The title pretty much tells you what the study is about, and what the study is about is that dietary supplements cause a lot of visits to the emergency room every year, 23,005 (95% confidence interval [CI], 18,611 to 27,398) emergency department visits per year can be attributed to adverse events related to dietary supplements.

Let's back it up a minute before I get into the study more. In the US, dietary supplements are regulated by the FDA (or, more appropriately, barely regulated by the FDA) under the Dietary Supplement Health and Education Act of 1994 (DSHEA), which is one of the worst laws ever passed or, as Peter Lipson calls it, a travesty of a mockery of a sham. Basically, supplements are considered more food than medicine and regulated as such. They can't be marketed for the treatment or prevention of disease (i.e. drug claims), but can make so-called "structure-function" claims (i.e., “boosts the immune system”). The problem is, what constitutes a “drug claim” compared to a “structure-function” claim remains fairly vague. Even after the FDA issued rules in 2000 that banned explicit claims that a product treats or prevents disease, there’s still considerable wiggle room, and enforcement isn’t exactly what I would call robust. In the meantime, supplement hawkers have cleverly used the Internet to circulate claims for these products that aren’t necessarily on the packages or in the package inserts. As Geller et al note:

Although supplements cannot be marketed for the treatment or prevention of disease, they are often taken to address symptoms or illnesses, as well as to maintain or improve overall health. The estimated number of supplement products increased from 4000 in 19943 to more than 55,000 in 2012 (the most recent year for which data are publicly available), and approximately half of all adults in the United States report having used at least one dietary supplement in the past month.5 In 2007, out-of-pocket expenditures for herbal or complementary nutritional products reached $14.8 billion, one third of the out-of-pocket expenditures for prescription drugs.6

We know supplements are big industry here in the US. Indeed, for whatever reason, Utah has become the state where the supplement industry is most concentrated, and as a result its politicians strongly support supplements. Senator Orrin Hatch (R-UT) has long been in the pocket of the supplement industry and is its most friendly lapdog and powerful defender. Rising star Representative Jason Chaffetz (R-UT), whom you might have heard about recently as a long shot candidate for Speaker of the House in the wake of John Boehner's resignation and the implosion of Kevin McCarthy's (R-CA) candidacy, has over the last few years been vying to outdo Hatch in demonstrating his fealty to the supplement industry. It's not just Utah politicians, though. There is the Congressional Dietary Supplement Caucus, which is bipartisan and has members from all over the country. It includes the aforementioned Chaffetz and Hatch, as well as Sen. Darrell Issa (R-CA), Rep. Frank Pallone (D-NJ), and Rep. Tom Cotton (R-AR). Thanks to the power of the supplement industry, thus far every attempt to tighten regulation of supplements since 1994 has failed. For example, in 2010, facing a primary challenge from the Tea Party, after having championed a bill to give the FDA more power to regulate dietary supplements, Sen. John McCain (R-AZ) caved because he decided that he couldn’t be perceived as being in favor of more government regulation.

As a result of the lack of regulation of dietary supplements, manufacturers and advocates make all sorts of de facto health claims for supplements such as that they can prevent or treat cancer and the like. FDA enforcement is sporadic and directed at only the most egregious, most immediately dangerous cases. Meanwhile, advocates, using the exaggeration of "food as medicine," continue to sell their products, many of which are scary substances manufactured under scary conditions, even though there is a distinct paucity of evidence for their usefulness.

The result is what we see in this study. Postmarketing reporting of adverse events from supplements by manufacturers is only required for the most serious events (e.g., those resulting in hospitalization, significant disability, or death), while voluntary reporting almost certainly greatly underestimates the incidence of adverse events. So Geller et al decided to use a national surveillance database to estimate the number of adverse events attributable to supplements that result in visits to the emergency room. They used the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance (NEISS-CADES) project conducted by the CDC, the FDA, and the Consumer Product Safety Commission. There are 63 hospitals participating in the project that make up a nationally representative probability sample drawn from all hospitals with at least six beds and 24-hour emergency departments with four strata based on hospital size and a fifth stratum for pediatric hospitals. Cases were identified thusly:

Trained abstractors at each hospital reviewed the clinical records of every emergency department visit to identify physician-diagnosed adverse events and reported up to 2 implicated products and 10 concomitant products, as described previously. Abstractors also recorded narrative descriptions of the event, including preceding circumstances, physician diagnoses, testing, treatments administered in the emergency department or by emergency medical services, and patient outcome. Narrative data were coded with the use of the Medical Dictionary for Regulatory Activities (MedDRA), version 9.1.

Geller et al looked at a ten year period from 2004 to 2013 for cases:

Cases were defined as emergency department visits for problems that the treating clinician explicitly attributed to the use of dietary supplements. This analysis included orally administered herbal or complementary nutritional products (including botanicals, microbial additives, and amino acids) and micronutrients (vitamins and minerals) but excluded products that are typically considered to be foods or drinks (e.g., energy drinks, herbal tea beverages). Additional products that are often used by consumers for complementary health but do not fall under the regulatory definition of dietary supplements (e.g., topically administered herbal or homeopathic products) were also included in the analysis. Herbal or complementary nutritional products were categorized according to common reasons for use...

Adverse events were categorized as adverse reactions, allergic reactions, excess doses, unsupervised ingestion by children, or other events (e.g., choking). Cases involving death on the way to the emergency department or after arrival were excluded because death registration practices vary among participating hospitals, and details about event circumstances are often lacking. Visits involving intentional self-harm, drug abuse, therapeutic failures, nonadherence, or withdrawal were also excluded. The categorization of symptoms was based on MedDRA-coded narratives.

When the analysis was done, on the basis of 3.667 cases identified in the database, Geller et al calculated an average of 23,005 emergency room visits for adverse events related to supplements and further estimated a 2,154 yearly hospitalizations. In the vast majority of these cases (88.3%), doctors attributed the adverse event to only one supplement, and the mean age of patients was 32 years, with more than a quarter of the visits due to patients between 20 and 34 years of age. Not surprisingly, people older than 65 were nearly twice as likely to be hospitalized. One-fifth of the visits involved unsupervised ingestion of supplements by children. (So, parents, lock your supplements up the way you do with your prescription and over-the-counter drugs.) There's a nice graph in the article that boils down a lot of information in a very compact package, including age of patients and what the product category was:

The age distribution of adverse events due to dietary supplements The age distribution of adverse events due to dietary supplements

Not surprisingly, in younger patients weight loss supplements were by far the largest category of supplements that caused adverse events. Similarly, not surprisingly, cardiac symptoms were the most common symptom associated with weight-loss products (42.9% of patients), and weight-loss or energy products were implicated in 71.8% of all ER visits for supplement-related adverse events involving palpitations, chest pain, or tachycardia. These were young people, too, the vast majority between 20 and 34 years old. Interestingly, among patients under 6 and 65 or older, swallowing problems caused a significant number of the ER visits. I don't find that too surprising, given the horse pill-sized capsules many supplements are often sold in. Calcium supplements were the worst offenders.

It's rather an odd coincidence that a couple of days before this study was published, the story of NBA star Lamar Odom's fight for his life after taking large quantities of "herbal Viagra" in a Nevada brothel hit the news in a big way. It should be noted, however, that Odom had also apparently been using cocaine and drinking Cognac; so it's difficult to know what the cause of his collapse was for sure, although it certainly could have been a combination of whatever was in the herbal product plus the cocaine, plus whatever else he was taking (and, according to E! News, he was taking a lot). Whatever the case, Odom is, by many reports, in bad shape, with TMZ.com reporting that failure of four organs, is on dialysis, and has suffered multiple small strokes. How many of these medical reports are true (considering the source) or not, the prognosis of multiorgan failure is very, very bad.

Whether the ten or more tablets of "herbal Viagra" that Odom took had anything to do with his condition or it was the cocaine, Cognac, and other drugs he was doing that landed him hear death, this NEJM study is yet more evidence that there are real consequences to the DSHEA and letting supplements be sold with, in essence, almost no regulation. Odom, if the herbs were the main reason for his collapse, would just be an extreme case.

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3.667 cases?

By Lowell Gilbert (not verified) on 16 Oct 2015 #permalink

Indeed, for whatever reason, Utah has become the state where the supplement industry is most concentrated, and as a result its politicians strongly support supplements.

Well one reason might be that supplements are a staple of the pyramid scheme multi-level marketing (MLM) industry.

http://pyramidschemealert.org/PSAMain/news/UtahScamState.html

23,005 (95% confidence interval [CI], 18,611 to 27,398) emergency department visits per year can be attributed to adverse events related to dietary supplements.

Being free of side-effects and risk of overdosage is one of the main supposed advantage, if not the main advantage of "natural" alt-med over "mainstream" medicine.
Well, so much for that.

In a previous thread, a drive-by poster left the usual accusation of mainstream medicine doing plenty of harm. In a pot, meet kettle way, allow me to bounce its words, properly edited, back at alt-med proponents:

Supplement medicine IS quackery, pure & simple. Until they begin archiving the perhaps millions of iatrogenic incidences that occur each year, we will never know just how big the scam really is.

Although I would moderate this by saying that there may be legitimate uses of real food supplements (vitamins and minerals in case of deficiencies, by example). So it is not full quackery from top to bottom. Close enough, unfortunately.

By Helianthus (not verified) on 16 Oct 2015 #permalink

Thank you for sharing your expertise so tirelessly, Orac! Your blog and others helps this cancer patient keep hold of her temper when someone recommends woo with a "works for me" testimony. They mean well, I don't need to make enemies, and I know I can't change their minds. (I believe we need more science education in the grades and high school to reverse this in future generations.)
You are doing good in the world.

By Justa Retiree (not verified) on 16 Oct 2015 #permalink

When I first saw the title of this post, my immediate assumption was that it would be about the Odom case. I'd heard some mention of his taking an herbal supplement that allegedly mimics a certain medication (the name of which has a tendency to trip spam filters on blogs that allow comments). But according to this study, it's a widespread problem, and the only two factors distinguishing Odom from the rest of that crowd are (1) he's moderately famous and (2) it's an extreme case.

By Eric Lund (not verified) on 16 Oct 2015 #permalink

One of the idiots I survey gets around the rules by saying that customers can look up what the product "can do" ( i.e. look through his materials or other woo-drenched lit) -btw- he and several of his faithful became ill on one of his products which was overloaded with vitamin D - one died IIRC.

The usual spiel is that -unlike meds, supplements have NO harmful effects.

I also recall that ephedra was implicated in quite a few cardiac events years ago.

I can hardly wait for the woo-meisters' reactions to the study.

By Denice Walter (not verified) on 16 Oct 2015 #permalink

One of the idiots I survey gets around the rules by saying that customers can look up what the product “can do” ( i.e. look through his materials or other woo-drenched lit)

IANAL, but if that's a valid legal workaround, then it's turtles all the way down. He's making certain claims in his marketing materials. I don't see how the material being on the web, as opposed to a radio or TV commercial, makes a difference.

Ephedra isn't the only example. I'm having a vague recollection of something called fen-phen (I'm not sure of the exact spelling), but I don't have time to look it up right now.

By Eric Lund (not verified) on 16 Oct 2015 #permalink

Fen-phen was the combination of fenfluramine/phentermine, both prescription medications, used together for weight loss, and they worked very well together. Fenfluramine and related drugs that were also used with phentermine cause pulmonary hypertension and valvular heart disease. They were pulled from the market back in the '80s. Phentermine is, however, not implicated in those effects.

By Old Rockin' Dave (not verified) on 16 Oct 2015 #permalink

@ Eric Lund:

That's how it works:
he refers people to written and SPOKEN materials- some of which occurs during his endless, droning daily internet radio/ radio shows- he reads off vaguely related studies, about say, cinnamon and vamps off on his own drift and then ,then sells a product with cinnamon ( or broccoli, grape, olive oil, red fruits, nuts, grains, phytonutrients etc.). Thus, it may not be a single *instance* but a global impression acquired by regular listeners. A legal case I suppose would have to go over hundreds of hours of material and put together thousands of hints and innuendo. People who study memory know how you can manipulate what listeners THINK they heard HOWEVER he lacks cautious speech and self-monitoring so I think that he HAS made claims for specific foods and nutrients. He has quite a few lawyers to guide him though.

By Denice Walter (not verified) on 16 Oct 2015 #permalink

@Denice #6:

I can hardly wait for the woo-meisters’ reactions to the study.

They'll probably crow about how few admissions were caused by homeopathic remedies compared to... gah, forget it. You can all take it from there.

By Rich Woods (not verified) on 16 Oct 2015 #permalink

It's very likely that the products that Lamar Odom was taking were made in China, a major center for allegedly herbal products that contain actual prescription-requiring pharmaceuticals.
I can't help but shake my head at the people who wouldn't buy food products from China because of all the adulteration/contamination scandals around them, but somehow think that capsules from China are somehow immune from that kind of thing. "But it's Chinese herbs!" was bad news coming from my patients, and it has not gone away in the years since.
I think they must have a mental image of Chinese herbals coming from an enigmatically wise Chinese graybeard in a dark little shop full of strange things in jars and chests of tiny drawers. Bad news, folks - that wise old man is DEAD for years. Your Chinese herbs were bottled by his grandson in a factory with smokestacks, noisy machines, and a rail siding, while he rides around in his Mercedes picking up prostitutes and bribing Party officials, if he and his factory are really in China at all, and not in New Jersey.
It's time to let the wise old herb doctor go to his rest once and for all.

By Old Rockin' Dave (not verified) on 16 Oct 2015 #permalink

If you want to get a feel for the response of at least some anti-vaccine people, Dr Pan posted this article here: https://www.facebook.com/RichardPanMD/posts/10153336829340674

Basically it's along the line of "more people are hospitalized by drugs" and "don't tell me what to put into my body."

I would suggest that people who want to claim they do their own research pay attention when new information comes out.

By Dorit Reiss (not verified) on 16 Oct 2015 #permalink

Sometimes the issues on RI have at least ≤i>some plausible scientific controversy, or at least require a bit of scientific sophistication to understand why certain practices are problematic...

And sometimes the wrong-ness at hand is just so blatant you feel the human race is doomed if this sh!t can be allowed to go on...

If supplements can have potentially beneficial effects because they contain drugs, then they can also produce adverse events because they contain drugs.

I'm utterly freaked-out Orac has to write that, because it's so f-ing obvious AND so blithely ignored by greed-heads exploiting the gullible. Call me cynical, but I can't believe supplement-slingers and their tools in government "forget" this. I have to conclude they know it, and just don't care. (I also don't believe anyone who has ever started an MLM 'business' has had any illusions that they're not running a Ponzi scam.)

I cannot chalk up 'supplements are food, not drugs' or 'food and drugs are mututally exclusive, so food shouldn't be regulated' to stupidity, only to... well... evil.
_______

The sad case of Lamar Odom may be useful in getting this study some pub, but it isn't really relevant. Odom had serious emotional problems, and was headed for self-destruction by any available means. Regulating supplements wouldn't have saved him. But sports are full of wide-spread supplement abuse. A lot of jocks – including plenty of otherwise 'normal' high-school kids – got seriously screwed-up on andro. When one magic pill gets whacked down, two more pop up to replace it. Just win, baby!
_______

I've been asking myself why magical thinking is so pervasive, and on a recent SBM thread I noted that magical claims have always been at the heart of virtually all advertising of mass-marketed products. Perhaps little-known fact: the earliest class of products to employ the methods of advertising-as-we-know-it were patent medicines.

But i'm also recalling the way 'science' was presented to the public in my youth (I was born 1953, and stuff from previous decades was till in circulation). 'Science' was depicted as uber-magic – fulfilling the promises of the magicians and alchemists because 'it actually works!' 'Science' would provide a simple and easy solution for everything. Need to clean house? The Jetson's-like automated system that will do it all with one push of a button is just around the corner! Got a health issue? No problem. If we don't already have a pill that will fix you right up, it'll be here before you know it! Want to be better than nature made you? 'Science' will provide a simple solution for that, too! (Check the early enthusiasm for LSD...)

(Not that any actual working scientists bought that line. But they weren't writing the copy,)

The critical scholarship on advertising has long grappled with the fact that advertising continues to work despite the fact products can't and don't live up to the magical claims made for them. Why don't people realize the claims are bogus, and just stop paying attention to the hype? The most common explanation: the fears and desires ad claims address are so deep, the general idea of their accessibility so reinforced by the whole sphere of ubiquitous promotion, that when any individual purchase fails its promise and leads to buyers remorse, the default mental path back to optimism is to go buy something else! (There's probably also a bit of woo-style blaming – if the magic didn't work for you, it must be your fault. But, hey, don't give up! The shelves are full of options, try again!)
________

Of course, some Libertarian is thinking none of this justifies regulation. Consumers will make rational choices; free enterprise regulates itself; under the invisible hand of the bad will fail and the good prevail. Except most buying decisions aren't rational. Except all kinds of bogus-claim-backed products have sold well for decades and decades. Except even if bad products eventually fail in the market, people die first. Think we don't need regulation? Google 'Tris' and then STFU.
________

However gullible the public may be to the magic promises of supplements, we do have a goverment that makes laws and creates regulations to protect its citizens. To anyone tasked with that, that supplements are drugs and should be regulated as such would seem to be a no-brainer. So why doesn't that happen? Who has the motive, and the power, to stand in the way? If we were just talking about the woo-ish supplement makers in Utah, websites like NN, and assorted MLM scammers, we could imagine that if the Tea Party loses their grip on Congress we could get some sensible reform. But there are big supplement sections in virtually every store that has a pharmacy counter – Target, WalMart, Walgreens, CVS. And with CVS positioning itself to take over a huge chunk of primary care with it's in-store 'clinics', I wouldn't bet on progress no matter who gets elected to what.

As far as supplements go, I'm feeling SBM's identification with Sisyphus might be too optimistic. At least Sisyphus moved the rock.

@#6, et alia

I am sure that it will be cooked as "look how few ER visits are prompted by our products compared to standard drugs." There may also be a sauce of "and these people did not follow directions for our natural, harmless stuff." Victim blaming and tu quoque. I will not be surprised to see attacks on the CDC and authors as being pharma shills.

I receive FDA updates all the time as part of my job. Many of these updates concern supplements with hidden drug content.

Many of these hidden drugs are banned in the US. I really wonder if these drugs are naturally present in the supplement or if naturally present they are at the strength found in the supplement.

I would think that many of these hidden drug ingredients are placed in the supplement so it has some semblance of acting the way statements say it will.

Of course usually when I see the words "supplements to improve your health or cure something" the first thing I do is protect my wallet.

@14–it’s already happened, in the NPR article that covered this study–they gave quite a lot of spacetime to a Naturopath who used it all on this sort of ‘damage control’:

Oh, yes. I expect a raft of posts and articles on quack websites arguing exactly the same thing. I'm guessing it's already started; I just haven't seen them yet.

I can hardly wait for the woo-meisters’ reactions to the study.

It was done by the CDC and the FDA and is therefore tainted. Big Pharma garble garble garble!

This swedish study was mentioned in sweden's tv I saw. Googling got this:

http://www.scientificamerican.com/article/antioxidants-may-make-cancer-…

Antioxidants were fed to mice -> "they developed twice as many tumors in their lymph nodes, a hallmark of the spread of cancer—a process called metastasis."
Supplements (with antioxidants) protect cancer cells.

Iron in supplements maybe dangerous to heart. In 80's iron was included in supplement pills here. Later (in 90's) they sold them without iron, this all - of course - in silence. Because of some heart attacks.., I think.

By MrrKAT, Finland, EU (not verified) on 16 Oct 2015 #permalink

Old Rockin' Dave@11:

I can’t help but shake my head at the people who wouldn’t buy food products from China because of all the adulteration/contamination scandals around them, but somehow think that capsules from China are somehow immune from that kind of thing.

Would these be the same people that like to complain on Facebook about how much the gubmint is watching them?

As awful as all the woo associated with supplements is, some are useful vitamin and mineral supplements which correct deficiencies and may be useful in treating some conditions.

But the other issue is that problem, ie 23,000 ER visits is dwarfed by the problems associated with conventional meds. 103,000 individuals are hospitalized annually in the United States for NSAID-related serious gastrointestinal complications at a cost in excess of two billion dollars and I recall that during the hearings on Vioxx, it was estimated that there may be as many as 15,000 deaths a year linked to NSAIDs. Look at the problems with prescription pain med overdoses.

In context, the problems with supplements is dwarfed by those associated with conventional medicine.

By Edward Murray (not verified) on 16 Oct 2015 #permalink

And, right on schedule (actually, later than I had expected), we have just the misguided argument we were talking about in the comments a couple of hours ago.

@ MrrKATT,

I've heard about those problems and warnings about high dosage vitamin E and Omega 3 fish oils. Of course, you've probably heard about high dose Calcium and possible heart events.

So far I haven't heard any response form the usual suspects BUT I imagine that they'll either compare the numbers to the 700 000 deaths** "caused" by SBM or say that Big Pharma fixed the studies ( since we all know that studies in scientific journals aren't to be trusted because of ghost writers, fixed data, thrown out studies and paid advertising by pharma.
Woo-meisters only trust their own studies or what their fave journals publish- i.e. the really awful rags they read..

** I believe that the number has settled around 700K despite much variation over the years.

By Denice Walter (not verified) on 16 Oct 2015 #permalink

Wow. No mention of the 1000,000 deaths per year from pharmaceuticals.

I agree that most supplements are inappropriate. but there are some that have merit:

Vitamin D
Epazote
Neem

Neem has a very unique molecule called Azadirachtin. This is a highly complex molecule that would be very expensive to synthesize in any significant amount. Plants synthesize many useful chemicals for us. Please do not discount this simple fact.

Ha ha!
I answered MrrKATT prior to Mr Murray's comment.

No, I'm not psychic but I am sickeningly familiar with my area

By Denice Walter (not verified) on 16 Oct 2015 #permalink

In context, the problems with supplements is dwarfed by those associated with conventional medicine.

So, these supplements should get a pass?

Your Chinese herbs were bottled by his grandson in a factory with smokestacks, noisy machines, and a rail siding, while he rides around in his Mercedes picking up prostitutes and bribing Party officials, if he and his factory are really in China at all, and not in New Jersey.

This. The same folks who are so worried about the provenance of their organic vegetables (and free-range chickens, for the non-vegetarians in the group) will consume supplements without giving them anywhere near the same degree of scrutiny. How do we know that the contents of the package bear more than coincidental resemblance to the contents claimed on the label?

The last comment about the factory location also raises an interesting point. If the supplements are being imported, then in principle Customs can spot-check the merchandise to make sure it's not a smuggling operation--granted, they probably don't do that often, but if they got a tip about somebody's imported Nonsenseoleum herbal supplement containing actual drugs that aren't supposed to be imported, they might take a look. But if the product is actually being manufactured in the US, then ICE is out of the loop, and unless the manufacturer is stupid enough to give the authorities grounds for a search warrant, it is likely to go undetected.

Either way, as you note, the manufacturer is pulling in money like their worst caricatures of Big Pharma.

By Eric Lund (not verified) on 16 Oct 2015 #permalink

it was estimated that there may be as many as 15,000 deaths a year linked to NSAIDs

Ah, the passive voice! Is there nothing it can't accomplish that can't be accomplished by it?

By herr doktor bimler (not verified) on 16 Oct 2015 #permalink

Apparently the "herbal Viagra" that Lamar Odom took contained actual Viagra, which was not listed on the label.

By Box Turtle (not verified) on 16 Oct 2015 #permalink

@ shay #27

You can't be accused of hoisting a logical fallacy if you don't make a claim, which may be why E. Murray didn't bother to attempt drawing any sort of conclusion. Because it would have been really dumb.

I agree that most supplements are inappropriate. but there are some that have merit:
[...]
Neem has a very unique molecule called Azadirachtin.

You're recommending a supplement as appropriate because it contains a powerful pesticide?

By herr doktor bimler (not verified) on 16 Oct 2015 #permalink

I agree that most supplements are inappropriate. but there are some that have merit:
Epazote

Having looked up Epazote I can believe that people might take it occasionally if they do not like the predictability and controlled dosages of prescription vermifuges. However, I struggle to imagine the conditions for which it would be appropriate as a *regular* dietary supplement, except perhaps delusory parasitosis.

By herr doktor bimler (not verified) on 16 Oct 2015 #permalink

herr doktor bimler beat me to it on the question of neem and azadirachtin. Way back in 2008 or earlier, I reviewed the scientific literature on neem and concluded that it was not safe for human ingestion. Yet, today, I see dietary supplements containing the leaves or extracts thereof.

The Council for Responsible Nutrition has was weighed in on the study in NEJM with a positive slant:

"The results of this study reinforce that dietary supplements are safe products, particularly when put into context with the number of people—over 150 million Americans—who take dietary supplements every year. To put this projected number of 23,000 annual emergency room (ER) visits into context, we estimate that far less than one tenth of one percent of dietary supplement users experience an emergency room visit annually. That percentage becomes even smaller when you eliminate the products that are not dietary supplements and exclude the ER visits that resulted from eye drops, ear drops, and other OTC and non-dietary supplement products inaccurately included by the researchers to make their projections for dietary supplements."

http://www.crnusa.org/CRNPR15-ContextKeyAERNEJM101415.html

For another take on the study, see:

http://www.nutraingredients-usa.com/Research/Weight-loss-and-energy-pro…

By Lighthorse (not verified) on 16 Oct 2015 #permalink

That percentage becomes even smaller when you eliminate the products that are not dietary supplements

Other than that, Mrs. Lincoln, how was the play?

I also smell a No True Scotsman in that: if it sends lots of people to the emergency room, then it can't be a dietary supplement. I can understand their argument that eye drops and ear drops aren't dietary supplements, but they are on shakier ground with anything intended for oral consumption.

By Eric Lund (not verified) on 17 Oct 2015 #permalink

Speaking of the ER, probly the 10th confirmed case of Influenza-b this week only in mine.

"I also smell a No True Scotsman in that: if it sends lots of people to the emergency room, then it can’t be a dietary supplement."

And if it's actually a dietary supplement that was involved, the victims clearly were Doing It Wrong.*

*oddly, alties never seem to extend this argument to prescription drug reactions/overdoses.

By Dangerous Bacon (not verified) on 17 Oct 2015 #permalink

The whole "conventional medicine causes more ER visits" meme is a red herring.
As in: The average number of Americans shot to death by toddlers runs to about one per week. This is vastly overshadowed by the number shot to death by adolescents and adults. So let's not worry about leaving the .357 loaded and off safety around the rugrats, because we might need it in a hurry to defend against those far more dangerous gangbangers and home invaders.
Which brings me 'round to "has" at #21. The people who worry about the gummint and the black helicopters don't buy Chinese products if they can help it anyway, 'cause socialists and all like that. The folk I was thinking of are more to the other side of the spectrum, the ones who buy cage-free Bolivian sea salt.

By Old Rockin' Dave (not verified) on 17 Oct 2015 #permalink

The "but pharmaceuticals are worse" argument is about like saying that since armed robbery is so horrible, picking pockets and tax fraud should be legalized.

Why such resistance to the idea of putting your supposedly innocuous supplements in a child-resistant bottle? What would be wrong with making smaller calcium supplements so elderly people didn't choke on them?

Vicki@42

Why such resistance to the idea of putting your supposedly innocuous supplements in a child-resistant bottle? What would be wrong with making smaller calcium supplements so elderly people didn’t choke on them?

More regulation = less profit

I get why Bug Supplement doesn't want to but what's up with all the hostility from the alt med fanboys/girls? Do they feel attacked and this is how they defend themselves? Is this just how people react when you shine a light on something they'd rather not acknowledge?

By capnkrunch (not verified) on 17 Oct 2015 #permalink

Ahem, Big Supplement.

By capnkrunch (not verified) on 17 Oct 2015 #permalink

The people who worry about the gummint and the black helicopters don’t buy Chinese products if they can help it anyway, ’cause socialists and all like that.

Assumes facts not in evidence, namely that the black helicopter crowd is worried about such details as logical consistency. They'll happily buy it from Wal-Mart if Wal-Mart stocks it. And we all know that Wal-Mart is interested in keeping the price low--they don't care whether the factory is in New Jersey, Oxfordshire, or Guangdong, as long as they can get the product cheap. Even the black helicopter types who do care enough to check the sourcing claimed on the package are likely to take the package's word for it--they don't stop to think that a supplement manufacturer who is not entirely honest about the product's benefits may be less than scrupulously honest about the sourcing of the product. Admittedly, that's because it doesn't occur to them that the claims about the product might not be accurate.

By Eric Lund (not verified) on 17 Oct 2015 #permalink

Bug Supplement
... which brings us back to Azadirachtin.

By herr doktor bimler (not verified) on 17 Oct 2015 #permalink

Natural products as a treatment for disease tend to be unreliable.

Even the use of citrus fruits as a treatment for scurvy was unreliable before Vitamin C was isolated.

By Joseph Hertzlinger (not verified) on 17 Oct 2015 #permalink

Which of the following are known to have or supply a "daily" intake requirement for humans?
Which are known to have properties well outside of foodstuffs?
- Vitamin D
- Epazote
- Neem

ephedra, opium, hashish, nux vomica, ...

Why should it be legal to market any product as a dietary supplement if it has or supplies no known requirement in diet? I think you could make a better case for formaldehyde as a dietary supplement than azadirachtin as one.

Does anyone happen to know the current most-used drug in legitimate medicine that is actually extracted from a plant rather than synthesized?
I guessing that in relatively recent history it was morphine and derivatives, but now?
Outside of legit medicine, it's gotta be yeast pee.

But yeast are fungi, not plants!

@doug #48: As defined by the FDA, although not one and the same by function, a dietary supplement (DS) may include essential nutrients. My personal bone of contention is with the term "nutritional supplements" which is widely applied by marketers to any and ALL dietary supplements. Short of any established nutrient, how can they be nutritional? And don't even get me started on "phytonutrients"! Marketers adopted that one because it sounds 'greener' than phytochemicals, regardless of the fact that a phytonutrient is a substance required by plants, but not necessarily people. And then there's "functional foods", defined by the Food and Nutrition Board of the Institute of Medicine in 1994 – the same year as the enactment of the Dietary Supplement Health and Education Act (DSHEA) – as "any food or food ingredient that may provide a health benefit beyond the traditional nutrients it contains." When that benefit is the prevention or treatment of disease, no matter what manufacturers, marketers, naturopaths, herbalists, "nutritionists", quacks, and members of U.S. congress may be dreaming or scheming, the food or its active constituent, whether added to foods as an ingredient or not, becomes a crude drug, but a drug nonetheless. Whereas science and history rightly use the term drug, it just doesn't sit well with marketers.

By Lighthorse (not verified) on 17 Oct 2015 #permalink

@doug #50: If you narrow that to prescription rather than OTC drugs, my first guess would be paclitaxel.

By Lighthorse (not verified) on 17 Oct 2015 #permalink

@doug: #50: OK. I'll bite. What's "yeast pee"?

By Lighthorse (not verified) on 17 Oct 2015 #permalink

That would be booze, a chemical waste excreted by the yeast cell to avoid poisoning itself. It has the side benefit of suppressing growth of bacteria, which sometimes fight back with acetic acid.

By Robert L Bell (not verified) on 17 Oct 2015 #permalink

Articles such as this are annoying and misleading because the author paints with a broad brush and indicts vitamins along with "supplements" in general, some of which, such as weight-loss products, can indeed cause harm.

The NEJM article stated, in reference to ER visits: "Such
visits commonly involve cardiovascular manifestations from weight-loss or energy products among young adults and swallowing problems, often associated with micronutrients, among older adults".

Okay, but let's not crucify vitamins because some elderly people have difficulty swallowing large tablets, which of course could be chopped up into smaller pieces, or capsules could be ingested, which are easier to swallow.

You are obviously part of conventional medicine, "Orac", so I am not surprised that you are practically trashing all supplements. I've taken vitamins and other supplements for 53 years... with no adverse reactions. I do not take any drugs, nor do I have any need for such. I do not even wear reading glasses at the age of 70, despite all of the books that I have written and a lifetime of extensive use of my eyes.

I am unaffected by such nonsensical articles or blog posts but young people might be influenced and that thought disturbs me. If any young people, in particular, are reading my comments, many scientific studies have been conducted, including at places like Harvard, which have showed the value of certain supplements for specific purposes. Do your own research. Read research articles in respected journals.

herr doktor bimler@29:

it was estimated that there may be as many as 15,000 deaths a year linked to NSAIDs

Ah, the passive voice! Is there nothing it can’t accomplish that can’t be accomplished by it?

Indeed. It's like a kitten turd on your rug.

I've been working on a presentation on most popular toxic plants in our gardens and let me put it this way - I already have 25 very popular plants and the list is by no means conclusive. And quite a lot of them contain substances that extracted, purified and then syntethized are powerful medication (colchicine, digoxin, atropine, to name but a few). Hopefully, the presentation will disabuse at least a few people of the notion that natural and plant-derived equals safe.

I was thinking the "animal, vegetable, mineral" thing when I counted yeast as plants.
My ol' Biology 529.04 (special topics in biology, mycology) prof would disapprove. There was a man man fond of a mug of dilute yeast pee.

@ Alia:

There are quite a few internet sites that list "plants not to have at home if you have a cat' / " outdoor plants that are deadly to cats".

By Denice Walter (not verified) on 18 Oct 2015 #permalink

Alia, do you have black henbane on your list?
I have no idea how widely it is still grown as an ornamental. Where I live, and in many places, it appears on noxious weed lists. I rather like it, in no small part because of the appearance of the seed pods. It doesn't seem very invasive here. I seems to do OK on recently disturbed soil, then gets choked out by native plants.

@HDB #34

Your comment immediately made me think of those parents who think their kid's autism is caused by a parasite infection - I suppose you could say they have a sort of delusional parasitosis by proxy. Obviously no responsible MD is going to give them a prescription antihelmintic, so it makes sense that they would seek out "natural" alternatives. I wonder if Epizote is going to be the new MMS, now that the FDA is finally starting to crack down on the latter.

I always thought that nutritional supplement was just another name for dessert.

If Big Supplement can't be bothered to sell small-enough vitamin and calcium supplements, I will indict them. The defenders of "complementary" medicine shout about incorrect dosages of prescription drugs; they don't shrug and say "pills can be cut" and "smaller dosages could be given."

The marketers of dangerous energy drinks and crap homeopathic nostrums have spent a couple of decades working to give their products an aura of reality and utility by grouping their "supplements" with vitamin D capsules, One result is that people assume energy drinks are safe because they believe vitamin A is always safe. A doctor might be able to get an answer to "are you using any vitamins or supplements," but it will be in terms of the marketing-promoted idea of a "supplement." If those companies want to work to repeal the DSHEA, and make it clear that B vitamins and calcium citrate are in fact different from energy drinks, coneflower extracts, and so on, I will applaud. But until then, they don't get to do a "no true Scotsman" in which a "supplement" means "those expensive pills, and only those expensive pills, that have not been called into question in the last fortnight."

@Denice Walter - yes, I've seen several such lists and I generally consult them when buying plants for my home, but this presentation is more general, not only about cats. And there are also a lot of myths over there, like a very popular story about a kid becomming severely ill after drinking water in which lilies-of-the-valley had stood. As it turns out, it's just an urban legend and anyway, as a friend of mine assured me, such water tastes horrible, so you would never ever drink a whole glass.

@doug - yes, I mention black henbane. Over here it's not an ornamental plant as such but it's a popular weed and many people may have it in their gardens just because it happened to sprout there.

I always thought that nutritional supplement was just another name for dessert.

The county board disapproves of team-building activities on the county's time, so we re-named our quarterly pot-lucks "nutritional conferences."

Alia try looking up Alnwick garden, which is devoted to poisomous plants.

There's a certain symmetry in that fungi makes alcohol which makes me a fun guy.

By Old Rockin' Dave (not verified) on 18 Oct 2015 #permalink

...MAKE alcohol...
Either too much or not enough of the nutritional supplement Old No. 7.

By Old Rockin' Dave (not verified) on 18 Oct 2015 #permalink

@ Alia # 66
I did drink lily of the valley water once. Someone couldn't find a vase so they used a glass and later on they removed the flowers... and it tasted normal enough as I got halfway through the glass before mom started freaking out. Nothing happened, though.

Some 30 years ago, a bunch of scientists went through the claims made about medicinal plants and the results were published in a lovely herbary. Most of the stuff was reclassified as either 'poisonous as hell' or 'obsolete, doesn't work as claimed'. The authors listed useful uses for various plants - those 30 years back, cigarettes made of some goddamn poisonous evil were used to treat asthma, for example (I'd prefer asthma to smoking anything, thankyouverymuch) but I don't know a MD in the right specialty and old enough to tell me more... I'd stick to inhalatory steroids, thankyouverymuch.

By kultakutri (not verified) on 18 Oct 2015 #permalink

@Old Rockin' Dave #69

GROAN!

On a happier note, that joke made my day.

By Robert L Bell (not verified) on 18 Oct 2015 #permalink

@ kultakutri:

I seem to recall vaguely that herbalists recommend smoking
- an old "Indian" herb- lobelia- for asthma AND
- smoking herbal substances which act like atropine ( not sure which herbs)
Neither seems particularly appealing.

Personally, a natural health advocate once told me, unsolicited of course, to throw my father's meds away and try herbs for heart failure- esp hawthorne and foxglove. Needless to say, I didn't.

By Denice Walter (not verified) on 18 Oct 2015 #permalink

@Alia #58: You might want to include kidney beans (Phaseolus vulgaris L.), which you may have noticed in most books on poisonous plants. Then there's goji or wolfberries (Lycium barbarum L.), which in some individuals will cause severe allergic reactions, including raised rashes and severe gastric disturbances, regardless of whether they are certified organic or not.

By Lighthorse (not verified) on 18 Oct 2015 #permalink

@Alia #58: For those who juice apples, it may be useful to note that half a teaspoonful of the seeds is enough to kill an infant.

By Lighthorse (not verified) on 18 Oct 2015 #permalink

@ Dangerous Bacon
Vitamin supplements have been used for about as long as I have been living (i.e., a very long time) and only in the past several years have questions been raised about their value and safety. Undoubtedly some of these people have agendas and certainly some writers are Big Pharma shills (one writer for Forbes.com has repeatedly been accused of being such).

Vitamin supplements used in a judicious manner are quite safe. Indeed, the second source you gave stated "taking the correct dosage was harmless". However, there is no such thing as a "correct dosage" because needs vary across individuals. Football players enduring two-a-day practices in extreme summer heat will have nutrient needs far greater than the needs of a 90 year-old sedentary person.

The idea of an RDA was developed during World War II with the objective of preventing disease. It has nothing to do with nutrient levels that are needed to achieve optimal health.

You first source is a blog article written by a PhD student who mentioned the Iowa Women's Health Study. That study was flawed and the flaws have been pointed out in various sources, including this one.
http://drhogg.com/health-articles/flawed-multivitamin-study/

I could write much more but I have neither the time nor the inclination to do so.

The Hogg Chiropractic Center: your one stop shop for high quality professional expertise on every topic. Bulk discounts available.

By Robert L Bell (not verified) on 18 Oct 2015 #permalink

statistical studies need to be taken with a grain of salt

OH NO SODIUM!!

By herr doktor bimler (not verified) on 18 Oct 2015 #permalink

I could write much more but I have neither the time nor the inclination to do so.

Something something Big Suppla shlls undertrained something.

Hogg, not Higg. Apparently these posts cannot be edited.

Apparently these posts cannot be edited.

See "undertrained" above.

@Tom #79: Under the section of "Supplement Facts", the same Alliance for Natural Health that you cite is warning its readings of an attack on "anti-aging supplements" by Senator McKaskill. What supplements have ever been proven to stop or reverse the aging process in humans? The site even goes so far as to claim that Hippocrates stated "let food by thy medicine and medicine by thy food". Right. Leaving aside the fact that Hippocrates never made the statement, supplements can hardly be called foods, even if the FDA was forced into regulating them as such.

By Lighthorse (not verified) on 18 Oct 2015 #permalink

kultakutri,

cigarettes made of some goddamn poisonous evil were used to treat asthma, for example

That would be thornapple (Datura stramonium). It's a spectacular plant (I grew some years ago) with evil-smelling leaves and fantastic spiny seed cases, but very dangerous. I have related here before how a friend unwittingly ingested some at a party (?!) and had hallucinations that he mistook for reality for two days afterwards; he was lucky to be alive IMO.

By Krebiozen (not verified) on 19 Oct 2015 #permalink

Tom,
I used to have high hopes for antioxidant supplements, I even have an ancient copy of 'Life Extension' by Pearson and Shaw somewhere, but research over the past few decades has relentlessly disillusioned me. These days I only take the occasional D3 and selenium, as I live in northern climes in a low selenium area. I think anything else is a waste of money that I prefer to spend on nutritious and delicious foodstuffs.

Vitamin supplements have been used for about as long as I have been living (i.e., a very long time) and only in the past several years have questions been raised about their value and safety.

Then isn't it about time we determined if they are of any value or indeed safe? Just because many people use vitamins for years with no obvious adverse effects doesn't mean there aren't any. Calcium supplements (but not dietary calcium) may cause more heart attacks than Vioxx, for example, but without large well-designed studies who would know?

Undoubtedly some of these people have agendas and certainly some writers are Big Pharma shills (one writer for Forbes.com has repeatedly been accused of being such).

Why would Big Pharma want to suppress supplement use? Most supplements are made by drug companies, Roche for example.

Vitamin supplements used in a judicious manner are quite safe.

How do you know this?

However, there is no such thing as a “correct dosage” because needs vary across individuals. Football players enduring two-a-day practices in extreme summer heat will have nutrient needs far greater than the needs of a 90 year-old sedentary person.

RDAs are constructed to (mostly) reflect those variations in requirements, but the altmed supplement industry is largely about megadoses of vitamins, so-called orthomolecular medicine. I think it's true that the vast majority of vitamin use is not supported by any convincing evidence.

The idea of an RDA was developed during World War II with the objective of preventing disease. It has nothing to do with nutrient levels that are needed to achieve optimal health.

There's the nub. Which nutrients do you think have benefits over and above preventing deficiency and what evidence do you have for this? As I wrote above, I no longer believe there is any advantage in taking supplemental antioxidants nutrients other than perhaps D3 and selenium, but if you have some compelling evidence I'm willing to be convinced.

I do think if there is a real argument about whether something is doing good or doing harm, in most cases it is unlikely to be doing very much of either.

By Krebiozen (not verified) on 19 Oct 2015 #permalink

Those who tout the ~700,000 deaths per year from pharmaceuticals always fail to mentions that likely most of those who succumbed were not exactly in the best state of health to begin with.

RobRN -- not to mention the # of those deaths that were overdoses by people who thought if one of these pain pills works, three or four will work even better.

I have related here before how a friend unwittingly ingested some at a party (?!) and had hallucinations that he mistook for reality for two days afterwards; he was lucky to be alive IMO.

“Luckily, I vomited most of it right back up,” he said. “But even so, I went blind for three days. Christ I couldn’t even walk! My whole body turned to wax. I was such a mess that they had to haul me back to the ranch house in a wheelbarrow… they said I was trying to talk, but I sounded like a raccoon.”

Thanks for all the suggestions - I looked at Alnwick site, it had some very interesting information. And I included quite a lot of popular plants - basically all members of solanum family are dangerous, even tomatoes and potatoes (unless you stick to those parts that are edible, of course).

Krebiozen, I don't have time for a detailed reply to you and others who are questioning the value of supplements, but I will just state briefly in response to your comments about antioxidants that they are indeed quite important and one of the most important of all is astaxanthin. See, e.g.,
http://www.huffingtonpost.com/suzy-cohen-rph/astaxanthin_b_2750910.html .

Regarding RDAs, they are quite low and are unrelated to levels of vitamins that people should ingest in seeking optimal health. There are many experts who would tell you that.

Glad to see Tom has discovered both the time and inclination to keep posting (probably for the benefit of impressionable young people). Attaboy!

"one of the most important of all is astaxanthin."

Orac actually covered this subject in a previous article (noting that while there might be some beneficial aspects to astaxanthin, there's an extreme paucity of clinical studies demonstrating efficacy:

http://scienceblogs.com/insolence/2011/01/19/dr-oz-finally-unequivocall…

"Undoubtedly some of these people have agendas and certainly some writers are Big Pharma shills (one writer for Forbes.com has repeatedly been accused of being such)."

And as we all know, anonymous accusations should be taken at face value.

I think Tom might benefit from reading a recently published book that is quite illuminating about supplement marketing and hype:

http://www.amazon.com/Do-You-Believe-Magic-Supplements/dp/0062222988

By Dangerous Bacon (not verified) on 21 Oct 2015 #permalink

Oh, I am well aware of Offit's propaganda book, Bacon, in which he trashes everything outside conventional medicine, including chiropractors and multivitamins. Before people waste their time reading that book, they should read the very detailed and insightful Amazon review of the book written a few years ago by Lucas.

You are doing the right thing by taking Vitamin D3 and selenium, Krebiozen, but you should take them daily, not just occasionally.

Vitamin E should also be taken daily. Forget the nonsense you read coming from some sources about Vitamin E being "dangerous." Virtually all of the studies of Vitamin E mentioned
in the media have been badly flawed. See http://drgeo.com/doctors-agree-on-vitamin-e-study-being-flawed
for example.

You should perhaps be taking 400 IUs of natural Vitamin E daily in the form of mixed tocopherols, which is what I do and which is recommended here http://www.naturalchoicesforwomen.com/index.php?option=com_content&task…

@ Krebiozen #85

It's funny.

We dismiss part of the harm done by "mainstream" drugs for being due to overdosing (and it has a big grain of truth - drugs are not sugar pills, and there is definitively too much of a good thing).

As exemplified by Tom, vitamins/food supplement proponents, on the other hand, keep telling us we are not taking enough of them. In other words, that we should be overdosing.

By Helianthus (not verified) on 21 Oct 2015 #permalink

Tom,

Krebiozen, I don’t have time for a detailed reply to you and others who are questioning the value of supplements, but I will just state briefly in response to your comments about antioxidants that they are indeed quite important and one of the most important of all is astaxanthin. See, e.g.,

I disagree. I have seen no evidence of long-term health benefits from astaxanthin, and some evidence of adverse effects from chronic carotenoid supplementation. I think the idea that filling our bodies with antioxidants will automatically be beneficial is very naive. Our metabolisms rely on a balance between oxidation and reduction, and trying to crudely shift that balance is unlikely to do any good.

Regarding RDAs, they are quite low and are unrelated to levels of vitamins that people should ingest in seeking optimal health.

What evidence do you have that any specific vitamin or nutrient has more beneficial effects on health when ingested as a supplement and not in food, in amounts greater than the RDA? If you look closely at how RDAs have been determined, as I have, I think you will understand that they are designed to be sure that almost everyone gets a sufficient amount.

There are many experts who would tell you that.

I spent more than two decades working with professors and PhDs in biochemistry who told me just the opposite. Who are these 'experts' you refer to? People like Suzy Cohen, a functional medicine practitioner who says she takes more vitamins than food? I don't regard her as a reliable source of dietary advice.

You are doing the right thing by taking Vitamin D3 and selenium, Krebiozen, but you should take them daily, not just occasionally.

I do take daily selenium (when I remember) because i live in an area (the UK) where soil selenium is low. If you live in the US, for example, adequate selenium is already present in your diet. Why would anyone require daily D3? I take a couple of 5,000 IU capsules each week in the winter which I regard as more than adequate.

Vitamin E should also be taken daily.

Why? Why can't I get sufficient vitamin E through eating food?

Forget the nonsense you read coming from some sources about Vitamin E being “dangerous.” Virtually all of the studies of Vitamin E mentioned in the media have been badly flawed.

I disagree. I think vitamin E supplements can lead to serious adverse events. Though the risks are low, why take them for no clear benefits.

See drgeo.com for example.

Why would I believe a naturopathic functional 'doctor' over the conventional doctors and scientists who trained me in clinical biochemistry? I see a lot of special pleading that mixed tocopherols have not been shown to be dangerous, but conversely they haven't been shown to be safe either.

You should perhaps be taking 400 IUs of natural Vitamin E daily in the form of mixed tocopherols, which is what I do and which is recommended here

Another recommendation from a naturopath (and acupuncturist in this case)? You should take a long hard look at the reliability of your sources. It looks to me as if you have been taken in by a bunch of quacks who are eager to sell you expensive and unnecessary supplements.

By Krebiozen (not verified) on 22 Oct 2015 #permalink

And, in Tom's opinion, there's obviously no risk to taking high doses of supplements. They're natural, man. All those cases of vitamin overdose problems I read in toxicology were made up by Big Pharma!

Like research indicating potential risk to vitamin E supplementation is "flawed" because they used synthetic vitamin E, which is way way different from "natural" vitamin E, because, well, because.*

*there's evidence "natural" E is taken up more readily by the body, but that shouldn't have affected findings of long-term disease risk with high-dose supplementation.

By Dangerous Bacon (not verified) on 22 Oct 2015 #permalink

My mother's been going on about probiotics, but she seems dubious about the pills, saying that we should be eating more fermented foods like we did before refrigeration: pickles, sauerkraut, kimchi, and such. Any ideas if this is true?

Also, apparently low-fat diets don't help people lose weight because they only leave people hungry for more. Again, anyone want to weigh in on this?

By Gray Falcon (not verified) on 22 Oct 2015 #permalink

Well some probiotic capsules are a bit dubious, but what is good for fermenting food (especially industrially) may not be the same strains that prefer humans, but a lot of that is unknown but at least some probiotic pills are from strains isolated from humans.

Personally I think most of the "it has to be from ancient fermented foods only" is just the natural is better than pill and ancient is better than modern tropes than any real hard data to back it up.

There is no one-size-fits-all rule with diets. A lot of if the low fat diet works for you still depends on controlling portion size and if you can stick with it. Like any other diet some 5% or so of those who try it can stick with it long term, but the same is true of all diets.

saying that we should be eating more fermented foods like we did before refrigeration: pickles, sauerkraut, kimchi

No lutefisk?

Krebiozen:

I take daily vitamin D because, for me, it's easier to remember a 1000-IU pill every evening than a larger one twice a week. Right now, I'm taking it year-round because that's easier than keeping track of when the sunlight is sufficient at this latitude and with our pattern of fog and cloudiness. But neither of those applies to everyone; most Americans, and for that matter most Canadians, live closer to the equator than I do.

Watch out for those fermented foods:

"New findings by a Queen's University research team dispel the popular notion that eating so-called "natural" foods will protect against cancer."

"In fact, certain types of common foods and alcoholic beverages such as wine, cheese, yogurt and bread contain trace amounts of carcinogens. Maintaining a balanced diet from a variety of sources -- including garlic -- is a better choice, the researchers suggest."

"Led by Dr. Poh-Gek Forkert of Queen's Department of Anatomy and Cell Biology, the team has discovered that a naturally-occurring carcinogen found in alcoholic beverages and fermented foods causes DNA modification and mutations, ultimately leading to abnormal cell growth and lung cancer. Her research also shows that a component of garlic significantly reduces these changes."

http://www.sciencedaily.com/releases/2007/03/070307152917.htm

So all you have to do is add lots of garlic to your sauerkraut. That'll probably eliminate any cancer risk, though you may wonder why your significant other has started sleeping in another room.

*note that other research does not find a relationship between eating fermented foods and mortality.

By Dangerous Bacon (not verified) on 22 Oct 2015 #permalink

So all you have to do is add lots of garlic to your sauerkraut. That’ll probably eliminate any cancer risk, though you may wonder why your significant other has started sleeping in another room.

Should add a measure of protection from any airborne viruses as well, since no one will want to get within five feet of you.

Vicki,

I take daily vitamin D because, for me, it’s easier to remember a 1000-IU pill every evening than a larger one twice a week.

That makes sense. There was a recent UK TV program that gave volunteers either D3, oily fish or 20 minutes outside with exposed skin every day and found they were more or less equivalent IIRC. As with the selenium I figure it is unlikely to do any harm and might do some good, though a brazil nut and a sardine each day would likely be just as good, truth be told. Incidentally, my neighbor's vitamin D levels were recently undetectable (she's a black South African) but she is always bouncing with health, though she should be dead according to the altmed folks.

By Krebiozen (not verified) on 22 Oct 2015 #permalink

I take D3 and will continue because my nephrologist says I should.
OT, my spellchecker insists that nephrologist should be "phrenologist."

Let me start by responding to the comments that some of you have made by stating that I am not exactly a novice regarding vitamins. I have used vitamins, generally in "megadoses", for over 50 years and I have read many research reports during that time. I continue to stay abreast of research through my memberships in the Alliance for Natural Health and the Life Extension Foundation.

Regarding Vitamin E, its considerable value has been known since the research of Drs. Evan and Wilfrid Shute in Canada during the 1930s and 1940s. I take 400 IUs of Vitamin E daily in the form of mixed tocopherols. I have done so for decades and at times I have used 800 IUs. Read this http://www.wholefoodsmagazine.com/columns/vitamin-connection/vitamin-e-…

Regarding Suzy Cohen, whom one of you wants to dismiss, do you want to also dismiss all of the references that she cited here that discuss the value of astaxanthin?
http://www.huffingtonpost.com/suzy-cohen-rph/astaxanthin_b_2750910.html

Of course a healthy diet should be sought and vitamin supplements should be just that, supplements.

Whereas it is possible to overdose on vitamins, it is hard to do so. It is almost impossible to do so on water soluble vitamins because the body passes off what it doesn't need. Guess what, in 53 years of taking vitamins and other supplements, I have never had a negative reaction. No trips to an ER, etc. People who write about the "dangers" of vitamins
are just spouting propaganda and undoubtedly many of them are Big Pharma shills.

Forget RDAs. Many people have nutrient needs that render RDAs meaninglesss, including competitive athletes and people who have more than a normal amount of stess at work and/or at home and consequently need considerable amounts of B-vitamins.

I continue to stay abreast of research through my memberships in the Alliance for Natural Health and the Life Extension Foundation.

Is this the same LEF that has dropped all pretense of "research" and is now simply a pill-mill?

By herr doktor bimler (not verified) on 22 Oct 2015 #permalink

No, that is just propaganda from you. I happen to have the April, 2015 issue of Life Extension Magazine at my fingerprints and there is one research article that has 91 references.

No, that is just propaganda from you

I'm looking at the Life Extension Foundation website, with the banner proudly promising "Highest Quality Supplements Since 1980", and it sure looks like a pill-mill to me.
The "About us" page tells the reader about the quality control of the pills... and the sources... and finally goes on to claim "In fact, we are much more than just a nutritional supplement company" (which is to say, "we are primarily a supplement company").

Are we talking about the same organisation?

It has certainly changed from the old LEF I used to know, but the old "www.lef.org" link redirects to this one.

By herr doktor bimler (not verified) on 22 Oct 2015 #permalink

"many of them are Big Pharma shills."

I have found this statement, and many like it, to be a reliable indicator of mordant crackpottery.

By Robert L Bell (not verified) on 22 Oct 2015 #permalink

Life Extension sells products; I don't buy anything from them because I can get better prices elsewhere. The health gurus Weil, Mercola, and Whitaker also sell products while providing their customers with info about important research results. It goes with the territory. No one with any objectivity and honesty could look at an issue of Life Extension Magazine and not admit that it contains obviously well-researched articles that have as many references as you would find in articles in prestigious professional journals.

Well, like it or not Bell, there are shills running around everywhere. Amazon has recently filed over 1,000 lawsuits against people (shills) who write phony reviews. These lowlifes advertise at fiverr.com and do their dirty work for only $5 per phony review.

One prominent person mentioned in this thread has been described by another prominent person mentioned in this thread as "a well-known shill for the vaccine industry". And he is indeed just that!

I'm sure that Big Pharma is paying many writers and one particular member of Congress to help them achieve their goal of driving vitamin companies out of business.

One prominent person mentioned in this thread has been described by another prominent person mentioned in this thread as “a well-known shill for the vaccine industry”. And he is indeed just that!

Said Tom the shill for Big Supplement. Said by someone who no doubt is of equal prominence somewhere as Tom is somewhere else.

So there, irrefutably proven. Exclamation mark.

Tom, as you are clearly in with the right people, how about you ask the Big Pharma Shill accounts department to send my cheques on? They really are slacking...

Mind, if the UK pharmaceutical companies are any indication they stopped even trying to bribe us with supermarket sandwiches many years ago 'cos their budgets were cut...

Tom,

Let me start by responding to the comments that some of you have made by stating that I am not exactly a novice regarding vitamins. I have used vitamins, generally in “megadoses”, for over 50 years and I have read many research reports during that time.

The number of years you have been taking supplements is irrelevant, it is the risks and benefits of those supplements that are the issue. I too have read many research papers over several decades but apparently I have come to conclusions opposite to those you have come to.

I continue to stay abreast of research through my memberships in the Alliance for Natural Health and the Life Extension Foundation.

These are not exactly neutral organizations. The ANH are, in my opinion, rabid nutcases (as far as I can tell there is no altmed madness they do not promote), and as HDB notes the LEF are little more than supplement pill sellers.

Regarding Vitamin E, its considerable value has been known since the research of Drs. Evan and Wilfrid Shute in Canada during the 1930s and 1940s. I take 400 IUs of Vitamin E daily in the form of mixed tocopherols. I have done so for decades and at times I have used 800 IUs.

Looking at a review of the literature I see equivocal research, some that found increased mortality, and little to suggest that supplementation has any advantages over a healthy diet.

Read this

I did, it's a review of the literature cherry-picked to make vitamin E look as good as possible.

Regarding Suzy Cohen, whom one of you wants to dismiss, do you want to also dismiss all of the references that she cited here that discuss the value of astaxanthin?

Her references? I see studies on mice, in vitro studies and a few very small human studies (mostly on eye strain), but no long-term human studies to demonstrate safety much less efficacy. Astaxanthin may be a useful therapeutic supplement (I took it experimentally for a couple of years a decade or two ago - it makes the skin turn a pleasant tan color as I recall) but I think it's too early to say. How do we know that astaxanthin doesn't lead to cardiovascular problems in the the way some COX-2 inhibiting NSAIDs do? That's a serious question.

Of course a healthy diet should be sought and vitamin supplements should be just that, supplements.

Why can't a healthy diet supply all the nutrients required except in a few cases like perhaps vitamin D and selenium or in specific conditions? I suggest you look at your diet and figure out what its nutrient content is. Then take a look at the RDAs, bearing in mind that they are designed so that almost everyone getting the RDA is getting adequate amounts of that nutrient. Perhaps you will see this is why some people want to convince you that RDAs are unreliable and that you need to buy their pills.

Whereas it is possible to overdose on vitamins, it is hard to do so. It is almost impossible to do so on water soluble vitamins because the body passes off what it doesn’t need. Guess what, in 53 years of taking vitamins and other supplements, I have never had a negative reaction. No trips to an ER, etc.

I could say the same about prescription drugs but that doesn't mean they are entirely safe, does it? I wonder how much money you have spent on supplements over that 53 year period. I would wager they had little if any effects on your health, though that is impossible to prove.

People who write about the “dangers” of vitamins are just spouting propaganda and undoubtedly many of them are Big Pharma shills.

I asked you before why Big Pharma would want to suppress supplement use, but you didn't respond. I don't believe that supplement use has much impact in Big Pharma profits, and if anything increases them as overall I suspect they do more harm than good. If you are suggesting they are suppressing supplements because they save lives and threaten profits, forgive me if I laugh out loud.

The propaganda I see here comes almost entirely from the supplement industry making ridiculously hyperbolic claims for their inadequately tested products.

Forget RDAs. Many people have nutrient needs that render RDAs meaninglesss, including competitive athletes and people who have more than a normal amount of stess at work and/or at home and consequently need considerable amounts of B-vitamins.

You have never had anything to do with establishing RDAs or reference ranges have you? Please provide evidence for a considerably increased B vitamin requirement over and a above the RDA due to "stress" since the evidence I can find does not support that claim..

By Krebiozen (not verified) on 23 Oct 2015 #permalink

Tom: Whereas it is possible to overdose on vitamins, it is hard to do so.

Fry up polar bear liver and onions and see how hard it is to overdose on a vitamin even from a natural source.

Hey Tom, What about the SELECT trial (Selenium and vitamin E to prevent prostate cancer)?
You know, the one that was halted because the interim data analysis showed an increase in prostate cancer among the men taking the vitamin E. Granted, it wasn't statistically significant, but it was enough that the trial was canceled. And later analysis (after more time had passed) showed that the men taking only the vitamin E supplement did have a statistically significantly increased risk of prostate cancer.

So maybe vitamin E isn't all it's cracked up to be, hmm?

By JustaTech (not verified) on 23 Oct 2015 #permalink

My responses here are about to end, Justa Tech, as it has become apparent to me that it is a total waste of my time to respond to messages posted here.

So I will just briefly state that it is well known that the SELECT study was highly flawed. The form of Vitamin E used in the study was dl-alpha tocopheryl acetate and anyone who knows anything at all about Vitamin E would never design a study that way! First, this was a synthetic form, as indicated by the "dl". Second, any study of Vitamin E should use mixed tocopherols, as alpha tocopherol alone can deplete important gamma tocopherol from the body.

For some diversion:
The following is from someone who regularly posts on CBC articles about drugs or vaccines, and clearly (not too apparent from this) is into the naturalistic fallacy, and also seems quite obsessed with carbonyls. S/he doesn't like it when anyone criticizes her/his spew.

Those that are held hostage by drug companies are only fooling themselves most of these drugs will kill you faster than the disease they where prescribed to treat. Synthetic drugs are made up of non self molecules so what that means is the drug itself triggers an immune response as it is looked at by your immune system as a pathogen. To counter act the response pharmacy uses immunosuppressive molecules in with the drug, which then leaves your body open to any opportunist infection be it caused by a virus, bacteria, poly-cyclic hydrocarbons, other medications, alcohols and even birth control pills. All you have to do is look at the contradictions when two or more drugs are combined and you will get the picture also a strong acid and or base will cause a violent reactions with medications that contain molecules of certain reactive carbonyl aldehydes like acrolein which is also produced endogenously due to oxidation lipids!

Whereas it is possible to overdose on vitamins, it is hard to do so.

Fry up polar bear liver and onions and see how hard it is to overdose on a vitamin

It was vitamin-A toxicity from husky livers that killed Mertz and nearly killed Mawson on the Australasian Antarctic expedition.

By herr doktor bimler (not verified) on 23 Oct 2015 #permalink

Life Extension sells products; [...] The health gurus Weil, Mercola, and Whitaker also sell products while providing their customers with info about important research results. It goes with the territory.

Does it go with the territory? Our host here seems to provide "info about important research results" without directing readers to his on-line shop.

I used to be in contact with the Life Extension Foundation back in the late 70s, when we couldn't troll people on the interwebs, we had to do it with cuneiform tablets typewritten letters (kids today don't realise how lucky they are). They were big on the calorie-restriction diet at the time, IIRC. That was soon after the cryogenics people split off as Alcor Life Extension (much as the original Amon Düül split into Amon Düül I and Amon Düül II).

Over the years the LEF shifted more and more to the supplements industry, but they retained a lot of libertarian politics and futurism and blue-sky speculation (with cross-overs with the nanotech crowd and the L5 society).

But just in the last year or two, they seem to have dropped everything that wasn't about supplements -- the politics and the calorie restriction -- and transformed into a on-line pill shop (with, to be fair, a side-line of looking for new pills, and new reasons to take the existing pills). New people in charge, perhaps?

By herr doktor bimler (not verified) on 23 Oct 2015 #permalink

The form of Vitamin E used in the study was dl-alpha tocopheryl acetate and anyone who knows anything at all about Vitamin E would never design a study that way!

What form of vitamin E is most commonly sold through US supplement outlets, and most commonly consumed? I have no idea (which is why I am asking). But if the usual pills are the alpha tocopheryl form, then that's the form that SELECT should have tested; and if the alpha tocopheryl form is less than ideal, then the fault lies with the supplement industry for selling it.

I see that the Linus Pauling Institute specifies α-tocopherol as the only form of any value. I looked at a few brands of Vitamin E -- including one from the LEF -- but the packaging didn't mention the kind of tocopherol, which seems remiss of them if it is a crucial issue.

If the use of non-alpha forms of Vitamin E is limited to a circle of informed cognoscenti, then they can argue that the results of the SELECT study does not apply to them, but that is irrelevant to the question of whether the results of the study apply to most people who buy pills at Walgreens.

By herr doktor bimler (not verified) on 23 Oct 2015 #permalink

@Tom,

My responses here are about to end, Justa Tech, as it has become apparent to me that it is a total waste of my time to respond to messages posted here.

What were you trying to achieve by commenting here? Perhaps you could have achieved your ends better if you'd included more facts and fewer unsubstantiated sweeping generalizations. But, that depends on what you wanted to do.

By Mephistopheles… (not verified) on 24 Oct 2015 #permalink

Well, first of all, herr doktor, nobody should buy vitamins at Walgreens because you will very likely be buying garbage!. Centrum Silver was used in at least one study of vitamins I know about, the results from which are often quoted.

Have any of you ever looked at the label of that product, which can be viewed on the Internet? If you did, you would see enough artificial colorings to kill a horse! Some of these are recognized carcinogens!! (see http://www.theatlantic.com/health/archive/2010/07/colorful-carcinogens-…) and should obviously be avoided (see http://www.cspinet.org/reports/chemcuisine.htm)

I think it should be obvious that there are people designing and conducting vitamin studies who are clueless. Anyone who has more than a superficial knowledge of Vitamin E knows that the vitamin in the form of alpha tocopherol only should be avoided.

This is one research article that explains how taking Vitamin E in the form of alpha tocopherol depletes gamma tocopherol from the body. Notice that the article was published 30 years ago! Gamma tocopherol plays an important role in normal body functions and some companies sell Vitamin E in the form of only gamma tocopherol.

4 - Handelman GJ, Machlin LJ, Fitch K, Weiter JJ, Dratz EA; oral alpha-tocopherol supplements decrease plasma gamma-tocopherol levels in humans. Journal of Nutrition 1985 Jun;115(6):807-13.

Well, O'BRien, when I encounter misinformation about vitamins, I respond to the people responsible for the misinformation.

These people are usually media people who obviously know very little about vitamins and just "read headlines". They then pass on the misinformation to their readers. Of course hardly any of them ever reply to me but I recall one person telling me that a quote from her was taken out of context.

Regarding your comment about facts, I am too busy to dig up a list of research articles that support what I am saying, but I COULD do so if I wanted to invest the time. I did list a research article in my previous message; I assumed that would be sufficient.

Have any of you ever looked at the label of that product, which can be viewed on the Internet? If you did, you would see enough artificial colorings to kill a horse! Some of these are recognized carcinogens!! (see http://www.theatlantic.com/health/archive/2010/07/colorful-carcinogens-…) and should obviously be avoided (see http://www.cspinet.org/reports/chemcuisine.htm.

It seems that we are in agreement that many if not most of the pills sold as 'dietary supplements' are more dangerous than useful, and the industry needs more oversight.

By herr doktor bimler (not verified) on 24 Oct 2015 #permalink

Tom: "Whereas it is possible to overdose on vitamins, it is hard to do so."

Gary Null (who became seriously ill because of an overdose of vitamin D from his own supplement) might disagree with you. By your logic, he was paid by Big Pharma to reveal his vitamin D near-death experience.

"I am too busy to dig up a list of research articles that support what I am saying, but I COULD do so if I wanted to invest the time."

But not too busy to post here over and over about how vitamins have been berry berry good to you, all studies showing health hazards from vitamin supplementation are flawed and anyone who questions vitamin pill-popping is probably a Pharma Shill.

Usually when alties start up with I-have-better-things-to-do-with-me-time it's with the realization that they're getting their butts kicked by critical thought-capable meanies, and it's high time to scurry off into the sunset (we should be so lucky in this case).

By Dangerous Bacon (not verified) on 24 Oct 2015 #permalink

Here is what happened to Null. A massive manufacturing blunder resulted in the following. " Instead of taking 2,000 IU of Vitamin D per day (the recommended upper limit), he had been wolfing down about two million. It is actually very difficult to overdose on Vitamin D, but two million IU a day is a good start."

Anybody would become very ill from such a blunder!! A blunder of the same magnitude regarding a trace mineral would also have disastrous consequences.

Let me tell you something Bacon, or whatever your name is, you would have absolutely no chance of winning a debate with me regarding the topics that we are discussing. None.

It is obvious to me that almost all of you who are posting messages here are either extremely close-minded or else you work in professions for which "alties", as you call them, are almost automatic adversaries.

If I cite research from peer-reviewed journals, you or someone else would probably say that I am cherry-picking. So why in the world should I waste my time posting messages here?

A massive manufacturing blunder resulted in the following. ” Instead of taking 2,000 IU of Vitamin D per day (the recommended upper limit), he had been wolfing down about two million.

[...]

Anybody would become very ill from such a blunder!! A blunder of the same magnitude regarding a trace mineral would also have disastrous consequences.

More evidence for the supplement industry requiring better oversight and outside regulation.

Let me tell you something Bacon, or whatever your name is, you would have absolutely no chance of winning a debate with me regarding the topics that we are discussing. None.

Well, he (and others) seems to have you on the defensive, and making excuses. So... prove it.

You don't even have to start by citing research articles, you might begin with answering questions people here have asked you, rather than making feeble veiled accusations of shilldom. Protip: that is not a winning strategy.

No, gaist, what happened to Null is an extreme manufacturing glitch that would not be expected to occur with other vitamin manufacturers. The supplement industry does not need "better oversight and outside regulation" and many of us are working with our Congressional representatives regarding this "threat". One of the U.S. senators from my state agrees with my position on this.

Now regarding those questions that you say I am not answering, I have looked all the way back to message #57 and I see only one question that I might have answered. If someone asks me about LEF and whether or not it has come under new leadership, I've been a member for only a few years, so how in the heck I am supposed to know?

I don' t make excuses, gaist. Support can be given for anything that I state.

Yes, herr doktor, there are dangers in some vitamin products, especially those made by pharmaceutical companies, but it is important to recognize, and for the media and others to understand, that it is the vitamin *products* (i.e., additives) that could cause problems, not the vitamins themselves.

So far this state of affairs has been distorted in the media.

Vitamins have been around for a very long time and people in general do not die from taking vitamins, or end up in ERs, etc.

Of course shills and people with agendas try to convince the general populace otherwise and the activities of one particular lowlife, who has some national visibility but who receives a ton of hate mail and occasional death threats, are being monitored and he will be targeted if he keeps lying about vitamins, with MDs and others responding to his lies.

Anyway, this is my last post here. It seems as though some of you think that you have all of the answers but that is obviously far from the truth.

If anyone wants to truly learn about vitamins (as is obviously the case for two people who recently contacted me in response to comments I made elsewhere), then the information is out there. You simply have to look in the right places.

what happened to Null is an extreme manufacturing glitch that would not be expected to occur with other vitamin manufacturers.

Is there any basis in reality for this claim? If so, what might it be? An 'extreme manufacturing glitch' is, almost by definition, 'would not be expected to occur,' but it did, anyway.

By Bill Price (not verified) on 24 Oct 2015 #permalink

Without agreeing with Tom, I learned stuff from his comments here and I encourage him to revisit in the future.

By herr doktor bimler (not verified) on 24 Oct 2015 #permalink

I've learned that supplement shills will say just about anything to prevent their processes from being scrutinized and regulated....I wonder why?

Tom,

My responses here are about to end, Justa Tech, as it has become apparent to me that it is a total waste of my time to respond to messages posted here.

You mean you don't have any evidence that stress leads to dramatically increased B vitamin requirements? Or evidence for the long-term safety and efficacy of astaxanthin? Or evidence that RDAs are "unrelated to levels of vitamins that people should ingest in seeking optimal health"? You can't tell me what reasons Big Pharma has for suppressing supplements? You have made quite a number of remarkable claims here, but the only evidence you have offered in support is extremely weak from naturopaths and vitamin pill peddlers.

Also, it seems ironic to me that you are pushing the benefits of non-alpha tocopherol (and presumably tocotrienols) when those are the forms of vitamin E found in the diet. You can avoid evil synthetic dl alpha tocopherol and get plenty of mixed natural vitamin E by simply eating plenty of nuts or sunflower seeds and leafy vegetables and not taking any supplements at all.

By Krebiozen (not verified) on 25 Oct 2015 #permalink

I'm just wondering why, if supplements are so safe, Tom never addressed the cases of overdoses (not even as drastic as Gary Null's) that have appeared in the literature. There's such nice chapters about vitamin overdosages and their effects in any standard Toxicology book.

Tom wrote:

what happened to Null is an extreme manufacturing glitch that would not be expected to occur with other vitamin manufacturers.

It was not a "manufacturing glitch" - it was a complete disregard for good manufacturing process and rudimentary quality control. This was an extreme case, but it appears that in many cases the ingredients don't match the label. Vendors are also able to hint at benefits that aren't backed up by credible research.

If a pharmaceutical manufacturer were to act that way, one would quite rightly want to shut it down.

By Mephistopheles… (not verified) on 25 Oct 2015 #permalink

Tom,

Let me tell you something Bacon, or whatever your name is, you would have absolutely no chance of winning a debate with me regarding the topics that we are discussing. None.

That is the very definition of closed-mindedness. No evidence will ever convince you that you are mistaken. That is sad.

It is obvious to me that almost all of you who are posting messages here are either extremely close-minded or else you work in professions for which “alties”, as you call them, are almost automatic adversaries.

I used to have beliefs not a million miles from yours in the past but have become cynical after reading paper after paper that shows little or no benefits (and sometimes advsere events) from supplements and other altmed interventions. My mind has been changed and I may change it again in the future. Yours, it seems, is welded shut.

If I cite research from peer-reviewed journals, you or someone else would probably say that I am cherry-picking. So why in the world should I waste my time posting messages here?

I suggest you stick to reviews and meta-analyses from reputable researchers who use internationally accepted criteria for assessing study quality. Cochrane is a reasonable place to start. That way no one can accuse you of cherry-picking.

Of course shills and people with agendas try to convince the general populace otherwise and the activities of one particular lowlife, who has some national visibility but who receives a ton of hate mail and occasional death threats, are being monitored and he will be targeted if he keeps lying about vitamins, with MDs and others responding to his lies.

Is this a veiled threat to Orac? If not, to whom?

Anyway, this is my last post here. It seems as though some of you think that you have all of the answers but that is obviously far from the truth.

It seems to me that the one who is misinformed here is you. I would wager that some of us here have read a great deal more than you on this subject; personally I have had to pass several examinations on vitamins and on occasion I have lectured doctors and scientists on antioxidants and free radicals. You, conversely, seem to have stumbled upon some very unreliable information sources that you have accepted uncritically and are berating others for not making the same error.

If anyone wants to truly learn about vitamins (as is obviously the case for two people who recently contacted me in response to comments I made elsewhere), then the information is out there. You simply have to look in the right places.

There I agree, but the Alliance for Natural Health and the Life Extension Foundation are most definitely not among them!

By Krebiozen (not verified) on 25 Oct 2015 #permalink

I had a look at the paper regarding how alpha tocopherol pushes out gamma.
My first hypothesis from this would be "gamma tocopherol is usable but inferior and absorbed when that is all that is available; alpha is superior and a mechanism of selective absorption has evolved."
That some companies produce only gamma supplement is completely irrelevant. Some companies, we are told, sell garbage.

If, indeed, the unsubstantiated claim that "at Walgreens ... you will very likely be buying garbage" is true, it certainly suggests to me that supplement sales need to be strictly regulated. I've never been in a Walgreens, and probably wouldn't have looked at the supplements if I had, but around where I live most pharmacies have no less than three brands of supplements to choose from, along with a house brand. So they're all garbage - or more useless than the secret squirrel brand only available to the self-appointed cognoscenti?

I just looked at walgreens.com to see what vitamin E they sell.

In the stores they sell these brands:
- Nature Made
- Finest Nutrition
- Walgreen's

Ingredients for Nature Made are: D Alpha Tocopherol Acetate (Vitamin E) , Gelatin , Glycerin , Water.

Ingredients for Finest Nutrition are: dl-Alpha Tocopheryl Acetate , Gelatin , Glycerin

Ingredients for the house brand are: dl-Alpha Tocopheryl Acetate , Gelatin , Glycerin , Purified Water USP

Online they also sell:
Nature's Bounty: Gelatin , Vegetable Glycerin , Soybean Oil (no indication of which tocopherols are present)
Botanic Choice: Gelatin , Vegetable Glycerin , Soybean Oil , Purified Water (no indication of which tocopherols are present)
Sundown Naturals: Gelatin , Vegetable Glycerin , Soybean Oil (no indication of which tocopherols are present)
Doctor's Best: Palm Oil Glycerides , Decaglycerol MonolaurateEmulsifier , Softgel CapsuleGelatin, Glycerin, Purified Water, Carob (no indication of which tocopherols are present)
Healthy Origins: Gelatin , Glycerin , Purified Water (says it has 1000 IU of Vitamin E, but no indication of what form or where it came from)
Carlson: Sunflower Oil , Beef Gelatin , Glycerin , Water (no indication of which tocopherols are present)
Live Extensions: Gelatin , Glycerin , Purified Water , Carob Bean (Ceratonia Siliqua) , Lecithin , Silica , Rosmarinus Officinalis (Rosemary) - this one claims a mixture of tocopherols with significant batch or bottle variation - Gamma E Mixed Tocopherols 359 mg
Gamma Tocopherol 215-244 mg
Delta Tocopherol 89-125 mg
Alpha Tocopherol Acetate (Vitamin E) 17-36 mg
Beta Tocopherol 0-7 mg)
Nature's Truth: Gelatin , Vegetable Glycerin , Soybean Oil (no indication of which tocopherols are present)
Nature's Way: Gelatin , Glycerin , Soybean Oil , Water (no indication of which tocopherols are present)
Jarrow Formulas: Gamma Tocopherol , Softgelgelatin, glycerin, water (contains Gamma Linoleic Acid)
Jarrow Formulas Famil-E: Soybean (Glycine Soja) Oil , SoftgelConsists of Gelatin , Glycerin , Water , Carob Bean (Ceratonia Siliqua) (D Gamma Tocopherol (D-Alpha, D-Beta, D-Gamma) 250 mg
Mixed Tocopherols (From Tocomin Palm Fruit Distillate) (Vitamin E) 38 mg)

By Mephistopheles… (not verified) on 25 Oct 2015 #permalink

"The supplement industry does not need “better oversight and outside regulation” and many of us are working with our Congressional representatives regarding this “threat”."

Supplement dealers' websites and others who advocate pill-popping as a solution to real and imaginary health complaints frequently rally the troops to respond to the "threat" of better regulation. When they shout "frog", customers like Tom jump.

I am disappointed that Tom suspect Dangerous Bacon is not my real name. Such a suspicious fellow...

But he has better things to do.

By Dangerous Bacon (not verified) on 25 Oct 2015 #permalink

Prompted by Meph's post, I went to Carlson's site (for no particular reason, relative to the others). There it is asserted that natural vitamin E is twice as good as the synthetic stuff, which is made from turpentine or petroleum.

Many of their products are alpha tocopherol from soy oil. Interestingly, they have an "Elite" line, which contains alpha (at 33 times the "daily value" for the 1000 IU version, a mere $77.50 for 60) plus beta, gamma and delta - which sort of suggests that they regard their standard product as inferior.

almost all of you who are posting messages here are either extremely close-minded or else you work in professions for which “alties”, as you call them, are almost automatic adversaries.

Why not both?

By herr doktor bimler (not verified) on 25 Oct 2015 #permalink

pushing the benefits of non-alpha tocopherol (and presumably tocotrienols) when those are the forms of vitamin E found in the diet. You can avoid evil synthetic dl alpha tocopherol and get plenty of mixed natural vitamin E by simply eating plenty of nuts or sunflower seeds

The scammers at Life Extension offer:
Gamma / delta triophenols (from palm-oil plantations);
Gamma triiophenols, with sesame lignans to increase bioavailability;
Gamma triiophenols, without sesame lignans, almost as if they don't actually care about bioavailability;
Vitamin supplements for dogs;
Multiple forms of of "d-alpha tocopherol from sunflower oil".

So the particular pill-mill that Tom extols as paragons of research integrity are taking natural sources, stripping out the important ingredients and leaving only the antagonists of dietary essentials, then selling these toxins to their clients.

It is almost as if they are mercenary sh1tweasels who care only about broadening their market and selling whatever fluff they can persuade the rubes to buy.

By herr doktor bimler (not verified) on 25 Oct 2015 #permalink

It is almost as if they are mercenary sh1tweasels who care only about broadening their market and selling whatever fluff they can persuade the rubes to buy.

Why herr doktor bimler - whatever can you mean? That's simply inconceivable!

By Mephistopheles… (not verified) on 25 Oct 2015 #permalink

The health gurus Weil, Mercola, and Whitaker also sell products while providing their customers with info about important research results. It goes with the territory.

I was not entirely convinced by the nomination of Weil and Mercola as proof that one can run commercial websites with the business model of selling pills, while successfully resisting the conflict of interest, so that one's advice on which pills to buy (and whether or not customers need pills at all) remains disinterested and unbiased.

I wondered how far this goes. How about Gary Null and 'Health Ranger' Mikey? Are they also trustworthy sources of the latest research information?

As noted earlier, I was not convinced that running a commercial website necessarily "goes with the territory" of "providing info about important research results".
Unless one is a hardline Randian Objectivist who does not trust any sources who are motivated by 'altruism' or 'concern for truth', and prefers to trust sources operating purely for gain.

By herr doktor bimler (not verified) on 25 Oct 2015 #permalink