Supplements Marketplace Confusion

Believe it or not, many supplement manufacturers do provide reliable product information. In fact, by law, supplement labels must bear Supplement Facts and claims that cannot mislead.

However, many companies don't abide by the supplement "rules." A regulatory environment that's less restrictive than the early 1990s has allowed more products and more misinformation to enter the marketplace, and deceptive marketing tactics are present throughout the supplement industry. For well-intentioned consumers—eager to take responsibility for their health—the sea of science and fiction is often confusing and misleading, and ultimately may be costly and harmful.

What misleading tactics may be used? Supplements are often promoted with pseudoscience. See "Ten Red Flags of Junk Science " in chapter 24.

  • Borrowed research. Study results that may or may not apply to the product: perhaps supplements with different potencies or formulations, or derived from different parts of the plant.
  • Distorted data. Information that's "spun" to match the product claim. Again, the formulation or dosage may differ from the supplement used in the original study. Less reputable manufacturers may present their

Other Supplements (Selected) : Claims, Effectiveness

Here's what the symbols mean:

T - Evidence comes from several controlled human studies.

T? - Preliminary evidence comes from only a few controlled human studies or from laboratory studies with cell or tissue samples. • - Evidence is uncertain and based on conflicting, controlled human research. 4- - Research doesn't support the claim.

4? - Preliminary evidence from a few controlled trials in humans does not support efficacy claims, but more research is needed. (Research that is negative and has only been performed in vitro is so designated in the column.) NR - Not enough human research has been done yet, or the research quality is poor.

Other

Media or

Also Be Aware . . .

Supplements

Marketing Claims

Effectiveness

Caution: Dietary supplements can pose significant and serious health

risks, related to dosage, length of use, health status, age, and inter

actions with drugs and nutrients. Before taking them, always talk to

your healthcare provider about their safety, risks, and interactions (not

fully listed beloW), especially when treating or managing health

conditions.

Acidophilus/

• Reduces lactose intolerance

NR

• No reports of serious adverse effects in human studies

lactobacillus

• Helps control rotaviral

Í

• Some products may contain little or no LA; some may contain

acidophilus

diarrhea (LA GG)

other strains of lactobacilli or contaminants

(LA)

• Prevents antibiotic-

^

associated diarrhea and

traveler's diarrhea

• Prevents or reduces length

^ (LA

of vaginal yeast infections

yogurt)

NR (LA sup-

plements)

• Controls irritable bowel

4

symptoms

• Prevents or reduces severity

NR

of atopic disease (allergies,

eczema, etc.)

• Reduces cholesterol

• Prevents cancer

NR

Bee pollen

• Enhances energy, athletic

NR

• Evidence supports safe use of 1 teaspoon/day for up to 30 days

performance

• Anaphylactic reaction in some sensitive individuals

• Reduces symptoms of PMS

NR

• Not advised for people with asthma or allergies to honey or bee

• Prevents gastrointestinal upset

NR

stings

• Reduces symptoms of chronic

NR

• Avoid if you have: liver disease

prostatitis (inflamed prostate)

• Avoid during pregnancy due to potential uterine stimulatory effects

• Enhances well-being; "nature's

4

perfect food"

Branched

• Builds muscle; reduces

NR

• Doses higher than 20 g may cause gastrointestinal distress and

chain amino

abdominal fat

may impair performance and induce fatigue

acids (BCAAs)

• Improves athletic

4

• May stimulate insulin release and affect medications used to treat

performance

high blood glucose

• Improves appetite in the

NR

elderly

• Helps mental function in

^

people with liver disease

Carnitine

• Improves heart health

T?

• No serious adverse effects reported with doses ranging from 0.5 to

(L-carnitine)

• Improves athletic

4

6 grams a day

performance

• Larger doses associated with nausea and diarrhea

Other Supplements (Selected)

: Claims, Effectiveness (continued)

Other

Media or

Supplements

Marketing Claims

Effectiveness

Also Be Aware . . .

Carnitine

• Increases energy in people

NR

• Avoid if you have: hypothyroidism, which may inhibit thyroid

(continued)

with chronic fatigue

hormone activity

syndrome or cancer

• May increase seizure frequency or severity if you have a history of

• Improves mental function

NR

seizures

in Alzheimer's disease

• Improves thyroid function

NR

• Reduces male infertility

^

• Improves immune function

NR

• Assists weight reduction

NR

Chondroitin

• Relieves osteoarthritis pain

Î?

• May cause epigastric pain, nausea, diarrhea, constipation

Sulfate

• Protects joints and tendons

NR

• May worsen asthma symptoms

from sports injury • Avoid if you have: (men) prostate cancer or higher prostate cancer risk from sports injury • Avoid if you have: (men) prostate cancer or higher prostate cancer risk

Coenzyme Q10

• Improves health of people

Î?

• No serious adverse effects reported for 200 mg CoQ10 daily for 1

(ubiquinone)

with heart disease and

year and 100 mg daily for up to 6 years

hypertension

• May cause mild gastrointestinal distress including nausea,

• Improves exercise

4

vomiting, diarrhea, appetite suppression, and heartburn

performance

• Note: coenzyme Q10 is produced in the body and aids in energy

• Reduces cancer risk

NR

production

• Improves immune function

NR

• May reduce effectiveness of some drugs (e.g., warfarin)

in individuals with HIV

• Helps with neurological

NR

disorders

• Prevents migraine headache

NR

Conjugated

• Helps control weight

4?

• No serious adverse effects found in short-term studies.

linoleic acid

• Stimulates immune function

4

• Most common side effect: gastrointestinal upset (diarrhea,

(CLA)

• Prevents cancer

NR

nausea, loose stools, and dyspepsia); fatigue also possible

• Reduces risk for heart disease

4

• Some forms may increase insulin resistance in individuals with

• Improves glucose tolerance

4

abdominal obesity or diabetes.

Creatine

• Increases muscle strength

Î?

• Avoid exceeding a dose of 2 to 5 g/day

and mass

• May cause weight gain/water retention, gastrointestinal pain,

• Delays fatigue in athletes

NR

nausea, or diarrhea.

• Increases strength in elderly

NR

• Avoid if you have: renal disease or insufficiency

• Increases strength in

Î?

muscular disease

• Increases strength in heart

NR

disease

DHEA

• Slows aging; improves

NR

• May increase breast, endometrial, or prostate cancer risks

(dehydro-

age-related memory loss

• For women, may promote masculine characteristics

epiandosterone)

• Improves immune function

• With chronic use, can alter hormone levels: unknown adverse

• Improves heart health

effects.

• Helps prevent cancer

NR

• May decrease HDL cholesterol levels

• Reduces symptoms of lupus

^

• Avoid if you have: breast, uterine, ovarian cancers; hormone-

• Improves health of

NR

sensitive conditions

individuals with AIDS

• Banned by the National Collegiate Athletic Association and the

• Assists weight reduction

International Olympic Committee

• Reduces menopausal

NR

symptoms

Fish oil,

• Reduces serum triglyceride

Î

• May prolong bleeding time

contains DHA

levels

• Should be monitored if you take anticoagulant medications or

(docosa-

• Reduces risk for athero

Î?

have blood clotting disorders

hexanoic acid)

sclerosis/heart disease

• Avoid before surgery

and EPA

• Improves glucose levels in

NR

• During pregnancy avoid fish oil supplements high in vitamin A

(eicosapent-

people with diabetes

(halibut and shark liver oils because of vitamin A's teratogenic

aenoic acid)

effects)

Other

Media or

Supplements

Marketing Claims

Effectiveness

Also Be Aware . . .

Fish oil

• Improves lipid levels in

t? (trigly-

• May cause belching, halitosis, heartburn, or gastrointestinal upset

(continued)

people with diabetes

ceride

• Up to 3 g/day considered safe; >3 g/day may suppress immune

levels)

function and may increase risk of hemorrhagic stroke

4? (LDL or

HDL cho-

lesterol

levels

• Reduces blood pressure

^

• Reduces inflammation and

t?

pain of arthritis

• Improves cognition in individ

NR

uals with Alzheimer's disease

• Reduces bowel inflammation

t?

in colitis or inflammatory

bowel disease

• Helps reduce severity of

4?

symptoms of psoriasis

• Helps treat depression

NR

• Helps treat attention deficit/

NR

hyperactivity disorder

• Prevents continued weight loss

NR

in people with cancer cachexia

(wasting)

• Reduces risk of cancer

4?

Flaxseed

• Improves blood lipids

• Doses more than 45 g flaxseed powder linked to loose bowels

• Reduces risk for heart

NR

• Can result in allergic and anaphylactic reactions

disease and stroke

• Not advised before surgery or for individuals with clotting

• Reduces risk of estrogen-

NR

disorders

related and other cancers

• Drink water when consuming whole or cracked flaxseed to

• Reduces inflammation in

NR

prevent intestinal blockage

individuals with arthritis

• Fiber in ground flaxseed can interfere with the absorption of

• Improves symptoms of

NR

other nutrients and some medications affected by fiber

lupus, eczema, and other

• May effect antidiabetes drugs; monitor blood glucose

inflammatory diseases

• No specific safe intake levels for women with breast, uterine, or

• Relieves constipation

t

ovarian cancers, endometriosis, or uterine fibroids

Gamma-

• Reduces PMS symptoms

• Not to be used with tricyclic antidepressants or anticonvulsants

linolenic

• Reduces inflammation in

• Borage seed shouldn't be taken if drugs with potential

acid (evening

rheumatoid arthritis

liver-related side effects are being taken, too.

primrose oil,

• Reduces atopic dermatitis

^

• Potential side effects include belching, bloating, nausea, vomiting,

black currant

• Reduces acne

NR

flatulence, soft stools, and diarrhea

oil, borage

• Improves diabetic neuropathy

NR

• Avoid before surgery

seed oil)

• Reduces cardiovascular

NR

• Should be monitored by a physician if taking anticoagulant drugs

disease risk NR

or supplements

• Reduces risk for breast cancer;

^

improves response of anti-

estrogen medications in

breast cancer

Glucosamine

• Relieves osteoarthritis pain in

• Derived from shellfish; possible reaction for those with shellfish

knee, hip, etc.

allergy

• In three-year studies, no serious adverse effects

• Some controversy regarding glucosamine and blood glucose

control. To be safe, people with diabetes should have glucose

levels monitored.

levels monitored.

  • UL: 3.5 g choline/day for adults age 19 years and older
  • Mild side effects are linked to high doses (20 g): gastrointestinal symptoms, urinary incontinence, and diarrhea
  • Excess choline (> 20 g) may cause a fishy odor
  • Ongoing use may affect the nervous system

Lecithin/ • Improves exercise endurance 4

choline • Improves dementia in 4?

Alzheimer's disease

  • Improves memory, concentration 4?
  • Improves liver health 4?

Other Supplements (Selected) : Claims, Effectiveness (continued)

Other

Media or

Supplements

Marketing Claims Effectiveness

Also Be Aware . . .

Lutein

• Treats age-related macular

Î?

• Not likely to have adverse effects, even with long-term use

degeneration

• Treats age-related cataracts

NR

• Treats retinitis pigmentosa

NR

• Prevents cancer

NR

Lycopene

• Decreases risk of prostate

^

• No scientific studies specifically evaluating the safety of lycopene

cancer

supplementation. Trials with supplements indicate safety at

• Prevents other cancers

NR

typical levels, usually at or below 30 mg/day over several weeks

• Reduces symptoms of

NR

exercise-induced asthma

• Prevents atherosclerosis

NR

Melatonin

• Regulates sleep-awake cycles

^

• Long-term effects and safety have not been studied. No harmful

• Reduces jet lag

Î?

effects reported from short-term use

• Reduces cancer risk; eases

NR

• Driving or using machinery for several hours after taking

side effects of cancer

melatonin not advised

treatment

• Morning use may affect alertness and reflexes

• Prevents and treats migraines

NR

• Do not take if using other sleep aids

• Enhances sex drive

NR

• Discuss with oncologist if undergoing chemotherapy

• Melatonin from animal pineal gland should be avoided due to

potential toxin contamination

Noni juice

• Prevents cancer

NR

• Approximately the same amount of potassium as orange juice

• Improves immunity

NR

• May reduce effectiveness of warfarin

• Reduces blood pressure

NR

• High potassium content can cause hyperkalemia in people with

• Improves cholesterol levels

NR

kidney disease

• Acts as a natural pain reliever

NR

Royal jelly

• Improves immunity

NR

• Not advised for people with asthma or a genetic predisposition to

• Contributes to a healthy heart

NR

allergies

• Improves stamina; reduces

NR

• Note: Royal jelly-exotic and expensive-isn't jelly, but instead a

fatigue

substance produced by worker bees to nourish future queen

• Reduces PMS

NR

bees

• Improves mental health,

NR

cognition

S-adenosyl-

• Reduces arthritis symptoms

Î?

• Mild gastrointestinal distress may occur at the beginning of use

methionine

• Reduces symptoms of

NR

• Safety well demonstrated for use as long as 2 years

(SAM-e)

fibromyalgia

• Reduces symptoms of

Î?

depression

• Improves liver health

Î?

• Promotes a healthy gallbladder

NR

Soy protein

• Reduces cholesterol levels in

Î?

• Avoid if you are: (women) diagnosed with breast cancer or at risk

and

individuals with hyper-

for breast cancer

isoflavones

cholesterolemia

• May reduce the absorption of thyroid medications

• Reduces risk of cancer

• Could interfere with estrogen replacement therapy

• Reduces menopausal

symptoms

• Reduces risk of osteoporosis

• Improves kidney function in

NR

people with both diabetes and

renal impairment

Shark cartilage

• Cures cancer

NR

• No reported adverse interactions

• Stops cancer spread (prevents

NR

tumor from developing a blood

supply)

• Prevents blood clotting

NR

• Treats psoriasis

NR

Other

Media or

Supplements

Marketing Claims

Effectiveness

Also Be Aware . . .

Spirulina/blue-

• Improves immunity

NR

• Vegans should not rely on spirulina as their sole source of

green algae

• Reduces cholesterol

NR

vitamin B12

• Reduces cancer risk

NR

• No long-term studies have evaluated the safety; has been

• Improves intestinal health

NR

consumed for centuries with few reports of adverse effects

• Aids weight loss

NR

• May be contaminated with microbes or heavy metals

• Patients with phenylketonuria should avoid consuming

spirulina due to potential phenylalanine content

Whey protein

• Builds muscle and improves

^

• No long-term human studies

exercise performance

• Should be avoided by those diagnosed with allergies or severe

• Improves immunity in

NR

sensitivities to milk or milk proteins

individuals with HIV

• For those with lactose intolerance, whey protein concentrate

• Acts as an anticancer agent

NR

contains lactose. Whey protein isolate has insignificant quantities

of lactose

• Excess amounts of protein can be harmful for those with kidney disease

Adapted from Allison Sarubin Fragakis with Cynthia A. Thomson, The Health Professional's Guide to Popular Dietary Supplements, third edition (Chicago: The American Dietetic Association, 2007).

• Excess amounts of protein can be harmful for those with kidney disease

Adapted from Allison Sarubin Fragakis with Cynthia A. Thomson, The Health Professional's Guide to Popular Dietary Supplements, third edition (Chicago: The American Dietetic Association, 2007).

"proof" in a format—charts and tables, cited references—that looks like a reliable research study.

  • Claims that research is under way. In other words, no specific data are available.
  • Unreliable studies. Poorly designed research that hasn't been published in peer-reviewed publications.
  • Testimonials. Statements, not based in sound science, from "satisfied" customers or celebrities.
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