Endurance News
May 24, 2017

Dietary Supplements, Health, and Performance: Let the Buyer Beware

By Matt Rogers

Thinkstock_072716_PILLSMost of us have seen posts on social media (or been cornered at a party or family gathering) by someone touting a great new line of products guaranteed to let you effortlessly lose weight, give you tons of energy, help you set a record in your next race, and provide you the winning numbers to next week’s lotto. They’ll even sign you up for a customer loyalty program that automatically ships your products, whether you want them or not, and bills your credit card each month. (How thoughtful!)
This kind of offer sets off alarm bells, with my first thought being the poster has been pulled in by a multi-level marketing (MLM) scheme and is desperate to unload the worthless products filling their garage and spare bedroom. Sadly, when I then Google the name of the company or product plus the word “scam”, I nearly always find my hunch was correct. Typically there will be numerous complaints on message boards and to various agencies about the products and the company, in addition to articles on how preposterous and biologically implausible the claims on products are (e.g., lotions and wraps that “melt fat”). There are usually defenders, too; mostly people who have the product to unload. Their comments generally blame the customer for not using the product correctly and urge them to keep trying for just a few more months.

A word of caution: Scammers know people use this search technique, so they put out glowing reviews with the word “scam” in the title that appear to be written by an objective third party  (e.g., “Miracle Weight Dropper, is it a Scam?”) .

A word of caution: Scammers know people use this search technique, so they put out glowing reviews with the word “scam” in the title that appear to be written by an objective third party (e.g., “Miracle Weight Dropper, is it a Scam?”) . The tip-offs are that the ‘reviewer’ gives a glowing review, often starting with “I was skeptical at first…”; confirming all the advertised benefits, few if any “cons”; and concluding it is not a scam but rather a true miracle elixir that tastes great, is less filling, and puts hair on your chest. If there are other product reviews on their site, they generally follow the same pattern (“Five star review for you! Five star review for you! Everybody gets a five star review!”). If you aren’t sure your Google results found genuine reviews, try legitimate sites like the Better Business Bureau, Federal Trade Commission (FTC), and National Consumer Protection Week (NCPW) which maintain lists of known scams.

MLM or otherwise, even skeptical folks get fooled sometimes, falling for some diet fad, bogus dietary supplement, chemophobic fear tactic, or questionable treatment that promises to cure an injury, improve our health, or make us better athletes. When it comes to dietary supplements, the first thing to remember is that the vast majority are a waste of money even if they aren’t fraudulent. Why? Because you generally don’t need them if you have a good diet in the first place. Even if your diet isn’t so good, it will be better improved with nutritional guidance rather than pills and potions. Keep in mind that nearly any pill or potion that can help you run faster or longer – beyond what food, caffeine, and hydration provide – is probably on the banned substance list. So unless your physician or registered dietitian has recommended something specific for you, you can relax; you probably aren’t missing any benefits by not using dietary supplements.

supplementsThat said, some products (such as protein powders) make for convenient workout nutrition, although as most of us know there are cheaper alternatives (got milk?) that work just as well, but might not keep as well in your hot car. Also, one supplement in my examples below shows some promise for reducing cramps (I’m not convinced, but I’m keeping an open mind). But as you will read, even with useful convenience supplements, you need to make sure what you purchase contains what the label says it does (and nothing it doesn’t).

If you do choose to try a dietary supplement, how do you avoid getting fooled or actually harmed? If you’re giving your bank account number to a deposed Nigerian Prince, or you’re still irked that I called MLMs a scheme, you might be too far gone; but for everyone else, I hope the tips presented here help you avoid giving your hard-earned dollars to people providing dubious products.

 

A closer look at dietary supplements
I’ve been reading a certain major running magazine since high school, and although it has changed publishers more
than once, one thing has remained constant: in nearly every issue, you will find advertisements for products that will effortlessly make you faster, stronger, lighter, and have the VO2max of Hermes himself.

Or at least – since 1994 – that’s what they imply they will do, using vague statements to stay out of trouble. Thanks to the disaster that is the Dietary Supplement Health and Education Act of 1994 (DSHEA), manufacturers are allowed to sell just about anything with no evidence of safety or efficacy (unlike FDA-approved medications and devices) as long as they don’t specifically say the product does anything. Per FDA rules, dietary supplements can “carry [vague] claims about the effect of a substance on maintaining the body’s normal structure or function” [as long as it carries the disclaimer:] “This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent disease.” Examples of vague claims are “supports joint health”, “supports a healthy immune system”, or “maintains brain function”. None of those claims actually mean anything. Also keep in mind DSHEA allows for ingredients to remain undisclosed under the guise of being a “proprietary blend”, which could be sawdust or stanozolol for all you know.

The tip here is to be on guard when you see a vague claim, “proprietary blend”, the FDA disclaimer, or all three. The sad reality is that, thanks to supplement industry–lobbying of some politicians with poor science literacy, DSHEA turned the normal rules of safety regulation on their head, making dietary supplements a caveat emptor (“let the buyer beware”) market in which the burden of proof is on the government to prove a dietary supplement is not safe and/or effective, rather than on the manufacturer to prove it is. DSHEA essentially reopened the patent medicine “snake oil” era.

Here’s a clip from the 2008 documentary Bigger, Stronger, Faster in which day laborers are hired to legally make supplements in the filmmaker’s kitchen. In short, the pills are mostly rice powder with a few grains of the ‘active ingredient’ (labeled a proprietary blend), and the ‘manufacturing’ conditions are rather unsanitary. Each bottle, they state, cost about $1.40 to make, but could be sold for $60.

A related tip is to read the Federal Trade Commission (FTC) Guidance on Dietary Supplements, especially the eye-opening information on the safety – or lack thereof – of supplements, including many tainted with drugs and other chemicals. Also, just because a product says it’s natural or organic or has been used since ancient times doesn’t mean it is safe. Plenty of natural substances can be quite toxic, and the term “natural” is virtually unregulated. The term “organic” relates only to a production method (organic farmers do use pesticides, by the way), not to quality or safety. It’s not that organic food isn’t generally safe, it’s that some manufacturers take advantage of the health halo effect – the unwarranted assumption that natural and organic labeled products aren’t just equal to, but are superior to, conventional products and are always “healthier” – to make you think their products are worthwhile and healthy. (Natural and organic cupcakes are still cupcakes, and should be consumed in moderation.)

As if all that weren’t enough to make you suspicious of dietary supplements, a New York state attorney general investigation found many herbal dietary supplements sold at major retailers did not even contain some or all of the listed ingredients, meaning that even if they were safe and effective, customers didn’t get what they paid for. What these products did contain, unsurprisingly, were contaminants and ingredients not listed on the label, including rice, wheat, daisy, alfalfa, pine, citrus, cassava, and houseplant DNA. I’m pretty sure that if you were allergic to any of those things, you would want to know they were in a product you planned to consume.

Real-world examples
Let’s look at three examples of advertisedproducts targeted at runners in one recent magazine issue, using the above
information and the following list of fraud tip-offs directly from the FTC
guidance document:

1. Claims that one product does it all and cures a wide variety of health problems. “Proven to treat rheumatism, arthritis, infections, prostate problems, ingrown toenails, ulcers, cancer, heart trouble, hardening of the arteries and more.”

2. Suggestions the product can treat or cure diseases. “Shrinks tumors,” “Cures impotency,” “Prevents severe memory loss.”

3. Words like scientific breakthrough, miraculous cure, exclusive product, secret ingredient, or ancient remedy. “A revolutionary innovation formulated by using proven principles of natural health-based medical science.”

4. Misleading use of scientific-sounding terms. “Molecule multiplicity,” “glucose metabolism,” “thermogenesis,” or “insulin receptor sites.”

5. Phony references to Nobel Prize winning technology or science. “Nobel Prize  Winning Technology,” or “Developed by two-time Nobel prize winner.”

6. Undocumented testimonials by patients or doctors claiming miraculous results. “My husband has Alzheimer’s disease. He began eating a teaspoonful of this product each day. And now, in just 22 days, he mowed the grass, cleaned out the garage, weeded the flower beds, and we take our morning walk again.”

7. Limited availability and a need to pay in advance. “Hurry. This offer will not last. Send us a check now to reserve your supply.”

8. Promises of no-risk money-back guarantees. “If after 30 days you have not lost at least 4 pounds each week, your uncashed check will be returned to you.”

One actual advertisement reads (sans product name), We just un-invented muscle cramps. Invented by a Nobel Prize-winning neuroscientist/endurance athlete. [Product] is a proprietary blend of organic ingredients scientifically proven to prevent and treat muscle cramps. This kick-ass formula stops muscle cramps where they start. At the nerve. So you can push harder, train longer, and finish stronger 1.7 FL OZ of Neuro Muscular Performance. Of interest, this ad does not contain the FDA disclaimer, despite making what a reasonable person might see as a health claim (“prevent and treat muscle cramps”). This advertisement has enough tip-offs to make a cautious reader investigate further, rather than jumping in and buying a case.

When I first saw the advertisement, I assumed the product was a spray. Using my Google-Fu skills, I found it is actually a spicy tasting drink, and – without getting into the details – does at least pass the basic science “plausibility test”; that is, the mechanism of action described does match some suspected pathways that could prevent cramps (the same pathways thought to make pickle juice effective). I also found that it actually was invented by a Nobel Prize winner (in Chemistry), so in this case it wasn’t a phony claim. The use of ‘proprietary blend’ (secret ingredients) to avoid listing ingredients is allowed by DSHEA, which I find frustrating. According to one journalist who was in the audience when the cramping research was presented at a recent sports medicine conference, the presenters would reveal neither the product ingredients nor the placebo control’s ingredients, and it wasn’t clear if they had the same taste. Also, since this research has not yet been published (presenting findings at a meeting has a much lower standard than peer-review for journal publication), I encourage caution.

Too often, enthusiastic inventors and their investors rush products to market based more on hope and hype than data. Stating that the formula is “scientifically proven” is premature, and shows a lack of the usual cautious language employed by scientists; we rarely use the term ‘proven’, knowing that new evidence could call our findings into question. (This is why you see findings that “demonstrate” or “indicate” or “suggest” or maybe “strongly suggest” a phenomenon, even when the study methodology is solid and the results are unlikely to be overturned.)

In this case, by investigating a bit further, I found there is some hope this product might do what it says; but at about $6 per dose, I would wait for more information before forking over my money. Besides seeing the published research, I also would want to know what’s in it. (The product is USP certified; more on that at the end of the article.) It is also concerning that, if they are so confident in their test results, they feel the need to have slick videos with athlete endorsers emphatically stating “it works” (anecdotal), hyperbolic “kick-ass” efficacy claims, and the inclusion of the halo-effect term ‘organic’ in their promotions. But I suppose the scientist left the advertising to the marketing people, who know customers demand certainty whether it is warranted or not. I’m curious as to how they got away with not including the FDA disclaimer, since this product seems to meet the criteria for being a dietary supplement and makes an apparent health claim that most likely was not evaluated by the FDA. To their credit, these folks seem to be attempting to make a legitimate product under good manufacturing practices, unlike very many dietary supplement makers. In this case, it seems prudent to wait; but probably only harmful to one’s pocketbook to forge ahead, assuming you aren’t concerned about potential allergic reactions to the secret ingredients.

Advertisement 2 reads (next to an image of a runner checking his watch): A refund if you don’t see results. Results if you do. Take the [product] Results or Refund three-week challenge. The cocoa flavanols in [product] supplement maintain a healthy flow of oxygen and nutrients to your blood vessels, important for your overall exercise performance. 100% money-back guarantee if you don’t feel a difference in three weeks.

The ad contains the FDA disclaimer (your first clue). Now that you know what you’re looking for, you’ve probably spotted the other tip-offs: vague claims about blood flow and exercise performance. Note it does not claim it will improve your exercise performance, just that it “maintains”– literally meaning ‘does not change’ – something that is “important” for performance. But if you aren’t paying attention to the clever wording, you would probably interpret this text, next to the speedy-runner photo, as meaning ‘this product will make you run faster’. Obviously, that’s the intention; but they can’t come right out and say that without getting in trouble. And of course, there’s also the money-back guarantee angle.

Following up on the implied claims, I found that the product is simply chocolate that has extra added plant sterols and flavanols. It is manufactured by a major candy company, although that in itself doesn’t make it unhealthy; all the major food companies own dozens to hundreds of brands that cross the spectrum from junk food to supposed “health food”. So, is there anything to the implied claims? According to a Harvard Heart Letter entry regarding the product, “plant sterols can lower cholesterol, and flavanols may keep healthy arteries flexible” (they do caution that the dosage needed requires eating 200 calories per day worth of the product, which could cause weight gain if not counterbalanced). Is that going to make you run faster? Is it even “important for your overall exercise performance”? It seems like a pretty big leap in logic to get from minor possible benefits for cholesterol and artery flexibility to that implied performance claim.

On the plus side, it probably tastes good and is unlikely to be any more harmful than a candy bar; unlike the tainted supplements discussed earlier, it is doubtful the parent company would risk allowing that and it is basically just fortified chocolate. As for the money-back guarantee in this instance, I suppose it’s good marketing, and I’m sure a major company would honor it (unlike less legitimate companies); but really, how are you supposed to know if it “worked,” or even what it was you were supposed to feel? If you expect it to work, then you might feel whatever results you thought you would; but are you going to know if it “maintained a healthy flow of oxygen and nutrients to your blood vessels”?

So, in this case, we have a product that is probably safe to consume, but appears to grossly exaggerate its (implied) potential health and performance benefits. I’ve seen these types of products come and go many times over the years. My guess is that people who try them get some placebo benefit early on (say, in the first three weeks, maybe?); but this wears off, as placebo effects do, and then the runner abandons the product (hopefully, not to dash off to look for the next easy performance enhancer).

Advertisement 3 is so obvious it’s a wonder anyone would fall for it, but the technique must work because marketers keep using it. It’s a full-page ad for a weight-loss supplement, formatted as if it was a magazine article (with the word ‘Advertisement’ at the top of the page, and a headline that announces it as a “Health-Watch Expose”). It is written in the style of a skeptical investigator who had to be convinced of the product’s validity. It contains undocumented testimonials (not a very good reporter, obviously), including a marathoner who – gasp – has more energy! Shockingly, the skeptical investigator was eventually won over by the “first 100% natural, organic, non-GMO nutritional shake and superfood.”

That’s a lot of nonsense in one sentence. But that’s not all: to get even more of a health halo effect, the product is made from grass-fed whey and not that icky grain most of us feed to our whey (I do take mine to the whey park regularly, and give it whey treats when it’s a good boy), plus a whole laundry list of other “superfoods” (‘superfoods’ is just marketing hype, but that’s another article). To top it off, they will enroll you in their loyalty program for automatic monthly shipment so you never miss out on losing weight, getting toned, and having your credit card charged. Of interest, nowhere in the ad – including the testimonials – do they claim anyone has lost weight using the product. I’m guessing that’s a tactic meant to avoid lawsuits.

I didn’t look too deeply into this one, since it can safely be dismissed based on the amount of hokum in the ad, but did find it was very expensive and shares its silly name with a baby stroller. There were a few of what appeared to be the dubious “is it a scam” reviews I discussed earlier that read like ads touting the product’s greatness. These things don’t inspire great trust, given that they are really just expensive milkshake powder with a health halo ingredients list. There’s no guarantee it contains what is listed, and even if it does, that it has any benefits that justify the price. As far as the loyalty program, many of the common complaints for this type of marketing involve how difficult it is to get out of the automatic shipment and payment systems. One reviewer noted a lack of transparency regarding the details of the cancellation policy, which is another tip-off that you might want to run the other way from this type of product and mix some fruit and yogurt in a blender instead.

The bottom line
Although some dietary supplement makers are trying to manufacture legitimate products, there are many products that are neither safe nor effective, don’t contain the listed ingredients, and may be contaminated. If you have a healthy diet and exercise regularly, you probably don’t need any dietary supplements anyway, so there is little reason to take the risk or waste the money on them. If you do decide to try something, remember it is a caveat emptor market – so be sure to watch for the tip-offs, and perform some due diligence before plunking down your hard-earned cash.

References:
1. Better Business Bureau: http://www.bbb.org/council/news-events/lists/bbb-scam-alerts/

2. Federal Trade Commission: https://www.consumer.ftc.gov/taxonomy/term/878

3. National Consumer Protection Week (NCPW): https://www.ncpw.gov/resource-topics/health-safety

4. Dietary Supplement Health and Education Act of 1994: https://ods.od.nih.gov/About/DSHEA_Wording.aspx

5. Clip from the 2008 documentary Bigger, Stronger, Faster: https://www.youtube.com/ watch?v=ThdFqGLq4QU

6. Federal Trade Commission (FTC) guidance on dietary supplements: https://www.consumer.ftc.gov/articles/0261-dietary-supplements

7. Organic farmers do use pesticides: http://www.ecfr.gov/cgi-bin/text-idx?c=ecfr&SID=9874504b6f1025eb0e6b67cadf9d3b40&rgn=div6&view=text&node=7:3.1.1.9.32.7&idno=7

8. The health halo effect: https://en.wikipedia.org/wiki/Health_halo

9. A New York state attorney general investigation: http://well.blogs.nytimes.com/2015/02/03/new-york-attorney-general-targets-supplements-at-major-retailers/?_r=2

10. US Pharmacopeial Convention (USP): http://www.usp.org/verification-services/usp-verified-dietary-supplements

11. NSF Certified for Sport program: http://www.nsfsport.com/listings/certified_products_results.asp

12. Consumer Lab: https://www.consumerlab.com/results/index.asp

13. Quackwatch Dietary Supplements, Herbs, and Hormones: http://www.quackwatch.com/01QuackeryRelatedTopics/DSH/suppsherbs.html

 

TEXT BOX

There are several trusted websites where you can check out supplements:

USP-PNGUS Pharmacopeial Convention (USP) tests and verifies dietary supplements to be sure they contain the listed ingredients and no contaminants. Products that meet their standard display a “USP verified” seal. (This doesn’t validate the product’s claims of effectiveness, just that it is high-quality and contains what it says it contains.)

 

NSFNSF International tests nutritional supplements for banned substances via its  Certified for Sport program. This is important particularly for athletes subject to drug testing, as some supplements have been found to be spiked with drugs such as anabolic steroids. This is a big enough problem that most college athletic programs instruct their players not to take any supplements unless obtained directly from their dietitian or athletic trainer.

 

consumer_labs

 

Consumer Lab also tests dietary supplements for quality and has other related information.

 

 

100px-QuackWatch_logo

 

Quackwatch covers many health-related scams and has a page devoted to Dietary Supplements, Herbs, and Hormones.

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