How the Gingko and Ginseng You're Buying May Actually Damage Your Health and Drain Your Wallet
When you take a dietary supplement, whether it’s a vitamin, mineral, herb or anything else, you expect to get the ingredients listed on the label and nothing more. You also anticipate it will benefit your health in some way.
But the New York attorney general's announcement last February that laboratory tests found serious problems with herbal supplements sold by major retailers has reignited the debate on whether dietary supplements need stronger regulation.
Attorney General Eric Schneiderman said DNA tests his office commissioned for herbal supplements, including Gingko biloba, St. John’s wort, ginseng, echinacea and saw palmetto, found none of the labeled substances in nearly 80 percent of the products, which were sold by GNC, Target, Walmart and Walgreen’s. He said many of the products contained contaminants not listed on the label, including rice, beans, wheat and even a houseplant, which he said posed a potential allergy or drug interaction risk.
Schneiderman’s action has raised questions about whether DNA testing was the right tool to investigate herbal supplement quality. Even some of those who support further regulation of the industry question whether that type of test alone was enough to justify the attorney general’s conclusions.
“The mistake they made is that you can’t reliably use a DNA test on extracts,” said Tod Cooperman, president and founder of ConsumerLab.com, one of three groups that test and certifies supplements.
Also questioning Schneiderman’s use of DNA testing was the United States Pharmacopeial Convention (USP), another testing and certification organization that sets testing standards for drugs, food ingredients and supplements in the U.S. and elsewhere.
The FDA spokeswoman told us the agency doesn’t use DNA sequencing for dietary supplement ingredient verification, relying instead on finding chemical markers or fingerprints for ingredient verification. But she said the agency “is actively working toward developing validated methods for plant identification, for use by both industry and the agency.”
Whether or not the attorney general’s testing was accurate, there is legitimate concern about the quality and efficacy of dietary supplements. Unlike with drugs, which can’t be sold until a company demonstrates their safety and efficacy, no federal approval is required for the sale of dietary supplements. To halt the sale of a supplement, the burden is on the government, which typically acts after a product already is in use.
It’s up to supplement manufacturers and retailers to decide which ingredients to include and to make sure their supplements are safe. But companies are not allowed to say that a supplement can prevent or cure an illness or other condition. They’re also required to have accurate ingredient labels on their products, although so-called proprietary blends don’t need to list the exact amount of the individual ingredient, which is why ConsumerLab.com doesn’t recommend them. Companies also are required to investigate and report complaints about serious adverse health reactions.
Quality is a problem. Just because a supplement is being offered in a glitzy print, broadcast or online ad doesn’t necessarily mean it’s being sold by a major retailer with a commitment to quality and safety. Wholesale supplies of supplements are hawked by manufacturers all over the world on such sites as the global marketplace Alibaba.com, which has tens of thousands of products available for bulk purchase by anyone with a credit card or access to Western Union. Many products can be customized with the buyer’s label.
We found one Chinese company offering “anti-age nutrition organic food supplement” tablets containing spirulina, a blue-green algae that research shows may have some health benefits, although none of the studies have been conclusive, says the University of Maryland Medical Center. Spirulina also can have bad side-effects and interactions with drugs that are given to suppress the immune system. And quality control is important because spirulina can be contaminated with toxic substances.
Cooperman of Consumer Lab.com estimates that as many as 50 percent of herbal supplements have quality problems, such as too little or too much of the advertised ingredients, contamination by substances not listed on the label, or poor disintegration in the body, which prevents their absorption. Testing by some groups has found supplements contaminated with aluminum, arsenic, cadmium, mercury and lead.
In contrast, Cooperman estimates that up to 10 percent of vitamins, minerals and other non-herbal supplements have quality concerns.
Gabriel Giancaspro, USPs vice president of foods, dietary supplements and herbal medicine, says herbal products are more likely to have quality issues because they are more complex than other types of supplements.
“There is very little question what a good vitamin looks like,” he said. “For many botanicals, the science is still evolving."
Some supplements have been found to contain harmful substances, a particular problem with products people buy to address sexual performance or sleep issues, lose weight or enhance athletic abilities.
In 2004, for example, the FDA banned ephedra, a plant used in supplements marketed for weight loss, increased energy and enhanced athletic performance, because of its association with stroke, heart problems and other issues, some of which could cause death. Following the ban, some companies began marketing their weight-loss products with bitter orange, which contains a chemical similar to the main ingredient in ephedra and which also can cause an increase in heart rate and blood pressure.
Does it do anything? Misinformation about the supplements’ capabilities, especially in herbal products, is rampant on the web, in print and elsewhere.
In its “6 things to keep in mind if you buy supplements online, the Center for Science in the Public Interest provides what a blow-by-blow account (pdf) of how a Texas company engineered a flawed health study to promote the sale of its green coffee extract weight-loss supplement. In September, the Federal Trade Commission announced that Applied Food Sciences agreed to pay $3.5 million to settle charges that it used the study to make baseless weight-loss claims to retailers, who then repeated them to consumers. The study also was touted on the Dr. Oz Show television program, the FTC said.
Federal law allows supplement companies to make only limited health claims, such as “calcium builds strong bones,” but only if they include disclaimers that any health-related statement has not been evaluated by the FDA and that the product is not intended to “diagnose, treat, cure or prevent any disease.” But those boilerplate notices have become so common in ads and product packaging that many consumers likely ignore them.
And a lot of supplement marketing uses testimonials and other gimmicks to imply that a product can treat illness or address a health-related condition like obesity or an enlarged prostate.
Even if a company crosses the legal line, regulators don’t have the sources to pursue every violation. And a lot of supplement marketing is done by companies outside the U.S.
One example of the problem is the proliferation of phony news websites that spring up after a supplement gets mentioned in a scientific study, no matter how preliminary or poorly construed, or mentioned by a celebrity medical professional.
In April, a federal court ordered an affiliate marketing network and its parent company to turn over nearly $12 million, which the Federal Trade Commission and the Connecticut attorney general said the businesses gained from using fake news sites to promote acai berry and colon cleanse weight-loss products. The National Center for Complementary and Integrative Health says there is “no definitive evidence that acai has any special health benefits.”
Another issue facing consumers is that there is a lot of changing science about the effects of supplements. A study that finds some benefit in a supplement today may be contradicted by additional research conducted tomorrow.
Last year, for instance, the U.S. Preventive Services Task Force, a group of experts that advises the government, recommended that people stop taking beta-carotene because it increases the risk of lung cancer in people already at increased risk for the disease. The group also advised against taking vitamin E, based on evidence that doing so provides no benefit.
Even if there’s definitive research demonstrating a supplement’s health benefits, the substance could have side effects or interactions with drugs or medical treatments. For example, antioxidant supplements, such as vitamins C and E, may reduce the effectiveness of some types of cancer chemotherapy, says the federal Office of Dietary Supplements. And St. John’s wort can accelerate the breakdown of many drugs, including antidepressants and birth control pills, reducing their effectiveness.
Stronger regulation needed? In April, New York’s Schneiderman and 13 other attorneys general called on Congress to launch “a comprehensive inquiry” into the herbal supplements industry,” including an examination into whether the FDA should be given greater oversight powers. They aren’t the only ones who have called for greater regulation.
The American Medical Association and the American Society of Health-System Pharmacists (pdf) have called on Congress to modify the Dietary Supplement Health and Education Act of 1994 to require, among other things, that the supplement industry demonstrate the safety and efficacy of its products.
Many critics of the law, the result of heavy lobbying by the supplements industry, say it tied the FDA’s hands by requiring that supplements be regulated in the same general category as foods.
They say that some supplements operate like medications, with some of the same risks and side effects. And unlike food, many people take supplements to address specific health needs.
Some people view supplements with a religious-like faith, taking as gospel the latest pronouncement from supplement gurus, no matter how lacking the scientific evidence supporting any health benefit. Those with a major illness may turn to supplements in desperation or because they fear the side effects of traditional medications or other treatments. Some consumers see any attempt at further regulation as an effort by regulators to protect drug manufacturers.
A big issue for the supplements industry is that it’s very expensive to conduct the studies needed to prove that a product is safe and effective in preventing or treating illnesses or other problems. That’s one reason why many prescription drugs are so costly.
And unlike with many drugs, it’s virtually impossible for a company, even after spending huge amounts on research, to obtain a patent on herbal compounds and other supplement ingredients.
What to Do
You can find the government’s current dietary guidelines at the federal Office of Disease Prevention and Health Promotion website. The Department of Agriculture’s What’s Cooking website provides healthy recipes, cookbooks and food fact sheets.
Follow your doctor’s instructions. If your doctor advises you to take a vitamin or any other supplement, go ahead. But even then, it’s worth doing some research and asking your physician about anything you don’t understand or are concerned about. If you’re trying to reduce your weight, increase your energy or address any other condition, discuss it with your doctor.
Don’t take a supplement simply because you’ve seen a news report or advertisement touting or implying some health benefit. And never substitute supplements for medications or treatments your doctor recommends.
Research using reliable sources. If you’re interested in finding out more about a supplement, don’t simply do a web search and assume that whatever you see is accurate or even honest.
Stick with trusted information sources, such as government health agencies, universities and reputable organizations that focus on major diseases and public health.
The National Institutes of Health’s Office of Dietary Supplement website offers dietary supplement fact sheets that provide extensive information for specific supplements, including potential benefits and risks and links to the latest research. You’ll also find a lot of general advice about supplements, including a helpful list of frequently asked questions and important dietary supplement facts. Other resources include the National Center for Complementary and Integrative Health and Consumer Reports’ vitamins and supplements webpage.
Once you’re taking a supplement, check the research periodically to make sure the latest findings don’t contradict what you’ve read in the past.
Verify with your doctor. Before starting a supplement, check with your doctor. If you’re seeking medical treatment or just having a routine physical, remind your doctor about the supplements you’re taking.
Look for independent review. It’s a good idea to look for certification by one of the three third-party verification services, especially if you’re considering an herbal supplement: The CL Approved Quality Product Seal from ConsumerLab.com; the USP Verified mark from the United States Pharmacopeial Convention; and the NSF label from NSF International.
The verification services use different standards. Find out more by visiting their websites and by reading the summary prepared by BerkeleyWellness.com, collaboration between the School of Public Health at the University of California, Berkeley and others.
Keep in mind that the groups don’t test every product, only samples. Supplements can vary by lot, and some retailers have more than one manufacturer or plant making a given supplement. USP and NSF also look at a product’s manufacturing facilities, among other criteria.
ConsumerLab is the only verification service that collects products from retailers, whether or not a company has requested certification, and publishes the reviews, good or bad. But to see them, you’ll need to purchase a membership ($36 for 12 months).
The one thing verification services don’t look at is whether a supplement has any health benefits. So don’t assume that a certification label means that a product is effective for anything.
Stick with major retailers. While buying supplements from major retailers such as a drug store chains or big discount stores doesn’t guarantee quality, there’s a better chance that large companies have the resources, know-how and clout to ensure that their suppliers are providing high-quality products.
The worst place to buy supplement is from an unknown website that you found by using a web search; saw in an online, broadcast or print ad; or that contacted you by email, text or in any other way.
Some unscrupulous online sellers of supplements offer free trials that require customers to provide a credit card number. Many people who have taken the bait have ended up being charged for future shipments they didn’t authorize or that they unknowingly consented to by ignoring the fine print.
Report problems. If you suspect that a supplement has made you ill, contact your doctor. Either you or your doctor should submit a report through the federal government’s safety reporting portal. You also can use the site to report suspected quality problems.
If you think you’ve been ripped off by a supplement company, file complaints with your state or local consumer protection agency, the Federal Trade Commission and the Better Business Bureau. If you used a credit card to buy the product, which is always a smart move, you should seek a chargeback from your card issuer.