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New concerns about the safety and quality of herbal supplements

If there is one aspect of “alternative” medicine that both critics and fans should agree on, it’s that products should be manufactured to high standards. What’s on the label should accurately describe what’s in the bottle. Product quality standards are essential, whether you’re using herbs or drugs. And when it comes to ensuring the products we buy are of high quality, we’re all effectively reliant on regulation to protect us. As a pharmacist, I can’t personally verify that each tablet in your prescription contains the active ingredient on the label. I am dependent on a supply chain that may stretch around the world. While the product manufacturer may be reputable, it’s only a regulator that can realistically verify and enforce production to strict quality standards. The same cannot be said for products like supplements and herbs which are regulated differently than drugs, and held to different, and in some cases, weaker standards. A weak regulatory framework, which doesn’t hold manufacturers to account, would be expected to result in a product of lower quality. And that’s exactly what you see when you look at supplements on the market today.

A new study paints a disturbing picture of the quality standards of herbal products commercially sold in Canada and North America. Entitled “DNA barcoding detects contamination and substitution in North American herbal products”, Steven G. Newmaster and colleagues from the University of Guelph in Ontario conducted authenticity testing of 44 herbal products. The authors have no personal bias against herbal medicines – the study was funded by non-commercial interests, and none of the authors reported any conflicts of interest. They’re actually quite positive about the therapeutic effects of herbal medicines, noting “there is considerable evidence of the health benefits of herbal medicine,” a statement that most at SBM would take issue with. The authors note a significant problem in the way these products are produced and distributed:

There are currently no best practices in place for identifying the species of the various ingredients used in herbal products. This is because the diagnostic morphological features of the plants on which the current Linnaean taxonomic system is based cannot typically be assessed from powdered or otherwise processed biomaterials. As a result, the marketplace is prone to contamination and possible product substitution, which dilute the effectiveness of otherwise useful remedies, lowering the perceived value of all related products because of a lack of consumer confidence in them. Herbal product substitution has been documented for many individual medicinal plant species, teas, and ‘nutraceuticals’. Although there is limited research available, the frequency of product mislabeling in herbal products has been estimated at 14% to 33% from previous studies. There are legitimate health concerns for consumers which results in a lack of confidence in safe, high quality herbal products.

Before we go into the study, it’s worth distinguishing between the physical characteristics of drug products and medicinal herbs. A surprising number of drugs we use today are derived from, or based on, chemicals originally found in nature. Acetylsalicylic acid (aspirin) is derived from salicin found in the bark of the willow tree. The antimalarial quinine is found in the bark of the Cinchona tree. Atropine was found in nightshade, and digitalis (digoxin) is what makes consuming the foxglove plant toxic. All had their origins as natural remedies. The benefit of drug products over herbs is the reproducibility of effects, which starts with isolating and purifying the active ingredient. The next step is manufacturing a dosage that results in consistency in absorption and standard and predictable dosages. Clinical trials establish if the drug has meaningful effects. So when I’m speaking with a patient about their new prescription drug, I know there’s a traceable relationship between the characteristics of product they’ve been dispensed and the drug product that was studied in the clinical trials. Consequently, it’s reasonable to expect the same outcomes and effects, based on this linkage. Even doing something as simple as changing the product from a tablet to a capsule may result in a regulator requiring bioequivalence study to confirm the effects are the same.

The rigorous controls in place for drug products don’t carry over to supplements. Many herbal products that are sold as “medicinal” contain a variety of chemical ingredients, several of which may have medicinal effects. If there was a clinical trial conducted, there is no simple way to verify that other versions of the plant contain the same combination of ingredients that produced the effects. Some herbal products do “standardize” one or more chemical constituents, where the suspected active ingredient is measured and verified in production. But even this isn’t an assurance of quality. Feverfew is a herb used to prevent and treat migraine, which is usually standardized to its content of the chemical parthenolide , the suspected actual ingredient. Yet there are dozens of chemical components in the feverfew leaf, and even standardized products cannot demonstrate effectiveness, which could mean that the active ingredient isn’t the parthenolide. Or it could be that feverfew simply doesn’t work. Without the purification and standardization offered by finding, isolating, and then testing the active ingredient, herbal products will always be at a disadvantage when it comes to quality, consistency, and predictability of effect.

Once we swallow a substance, be it a herb or a drug, our body can’t distinguish the difference. Chemicals are absorbed into the bloodstream, circulate in the body, and presumably reach the site of action and then have some sort of biological effect. They are eventually excreted, sometimes only after being transformed in the liver. The more consistent the original product, the more predictable the response in the body. Given the similarities of how herbs and drugs behave in the body, it’s hard to understand the rationale for a completely different regulatory standard for herbs. In the USA, it’s the Dietary Supplement Health and Education Act (DSHEA) that creates a double standard. In Canada, it’s the Natural Health Products Regulations. They are similar in that they implement some manufacturing and safety standards, while essentially eliminating the requirement to demonstrate that the product actually does anything useful. DSHEA goes so far as to put the requirement to demonstrate harm on the FDA, instead of requiring the manufacturer to demonstrate that a product is safe and effective. Canada regulates differently, but to an equally low standard. As I’ve pointed out before, the Natural Health Product Regulations have had a similar effect at creating a manufacturer-friendly market: Pretty much anything goes, and even homeopathic cancer, homeopathic corn, and homeopathic water (think about that one) have been approved by Health Canada as “safe and effective”. And when it comes to herbs, Health Canada approves products that are said to “tonify the kidney and fortify the yan“.

The separate regulatory systems for natural products, supplements and herbs in Canada and the United States have led to a boon in the development and sale of these products. The barriers to establishing a business are trivial compared to drugs. Importantly, there’s no requirement to actually demonstrate your product works. There’s not even a requirement to show your product is consistent batch-to-batch, because to show that you’d first need to demonstrate some objective and measurable effects. Finally and most importantly, there’s really no simple way for a regulator to actually test to see if what you’re putting in the capsule (for herbs) is actually what you say. Until now, and the technology used by Newmaster. It’s called DNA barcoding, which essentially treats DNA strands like UPC codes, examining and distinguishing between different species.

The researchers purchased herbal products for sale in Toronto, Canada and via mail order from the United States. Twelve manufacturers were involved, representing 44 products (41 capsules, 2 powders, 1 tablet). They also obtained 50 samples of known products from greenhouses. Both were studied in a blinded fashion. In total there were 30 herbal species, and these were studied against a barcoded “library” of over 100 species. Their definitions were as follows:

  • Authentic: a product contained the DNA barcode for a species that was the main ingredient on the label.
  • Contaminated: contains labelled ingredient and also the DNA barcode for a species not on the label.
  • Substitution: a product contained the DNA barcode for a species not on the label, and there was no trace of the labelled ingredient.

Here were the results:

Newmaster Figure 2

The findings are dismal and quite discouraging for consumers and health professionals alike. Only 48% of products were authentic. 59% of the products contained species not listed on the label. One-third contained fillers and contaminants that were not labeled. Amazingly, another third of products tested contained a substituted ingredient – and none of the labeled ingredient. Of the 12 companies sampled, only two had authentic products without any substitution, contaminants, and fillers. Unlabelled fillers including wheat, soy, and rice, were found in 20% of products. Three companies had products for which no products could be authenticated:

Figure 3

Some of the products were of such poor quality that harms could be expected. One sample was labelled as containing St. John’s wort (used to treat depression) but actually only contained senna, a laxative. Several products were contaminated with feverfew, which has chemical ingredients that can cause side effects, including withdrawal syndromes. Feverfew may also interfere with the elimination of some prescription drugs, and needs to be avoided in pregnancy. Another product was contaminated with black walnut, which has a nasty side effect profile. And there’s also the undisclosed wheat in some products, which would be harmful to those with Celiac disease or a wheat allergy.

This is far from the first sign that there are issues with supplement quality standards. Earlier this year I wrote about the frequency and characteristics of dietary supplement recalls in the USA. That study noted that every supplement recalled between 2004 and 2012 was due to unapproved ingredients. But recalls don’t give us a comprehensive summary based on sampling – which is where this study excels. Other studies have raised similar concerns:

The implications

Without reliable, consistent products, consumers can’t use herbs safely, or even assume they might work as expected. Health professionals are in a similar bind, and can’t make recommendations without high-quality products to rely on. For my entire career I’ve cautioned consumers about the quality concerns with herbal products and supplements, and the resultant risks that make me very hesitant about their use. And in the absence of good evidence of benefit, the potential risks take on more importance. There’s no question that legislation like DSHEA has created a tremendous business opportunity for manufacturers. The market is comparatively easier for manufacturers to enter. Combine this with little requirement to test products, or substantiate claims they even work, and you get a market where product contamination and substitution appears commonplace. It’s exactly what you’d predict if you loosened or eliminated the regulation of prescription drugs. Supplements do share one key feature with prescription drugs: this is big business, a $28 billion market in the US in 2010, with year-over-year growth exceeding 5% annually for the past several years. And the industry is actively behaving in ways that don’t favor consumers, such as fighting moves to give consumers more information about their products.

Perhaps not surprisingly, the supplement industry rejects this latest study, raising some minor criticisms (e.g., asking for reproducibility) but also handwaving away the overall conclusions, with no acknowledgment of the serious nature of these findings. If herbs actually have medicinal effects, then contamination of this nature and scale should be unacceptable within the industry. It’s a disappointing response, because if there’s a single issue that threatens true science-based use of herbs and supplements, it’s product contamination and adulteration worries. And that’s exactly what’s starting to occur. Last month the Children’s Hospital of Philadelphia announced it was no longer supplying supplements, and would discourage patients’ families from their use. Why?

’Because vitamins and dietary supplements are essentially unregulated, there is no sound information about adverse side effects, drug interactions, or even standard dosing for the vast majority of them,” said Sarah Erush, CHOP Pharmacy Clinical Manager and a member of the hospital’s Therapeutic Standards Committee, which recommended the policy change that was rolled out over the summer. “Administering these medications — particularly to children with serious health complications — is unethical when the risks are unknown, and when there are alternative treatments that have been proven in clinical trials to be safe and effective,” Erush said.

Conclusion

This new study joins several others in pointing out serious quality concerns with herbal products sold today. Substantive improvements are necessary to bring the quality of herbal products in line with conventional drug products. And until supplements demonstrate reliable and consistent quality, they cannot be counted on to actually deliver any predictable health effects. Yet without effective regulation to mandate and enforce better standards, there is no external pressure for change. Lax regulation has been a boon to manufacturers, and the supplement industry has exploded. It’s unfortunate that the same conditions actually make it harder to find products that are safe and effective. Until these products are held to more rigorous quality standards, consumers will continue to pay a form of health roulette each time they purchase a herbal supplement.

Reference

Newmaster S.G., Grguric M., Shanmughanandhan D., Ramalingam S. & Ragupathy S. (2013). DNA barcoding detects contamination and substitution in North American herbal products, BMC Medicine, 11 (1) 222. DOI:

Posted in: Herbs & Supplements, Science and Medicine

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43 thoughts on “New concerns about the safety and quality of herbal supplements

  1. Jeff says:

    Scott writes,

    “Perhaps not surprisingly, the supplement industry rejects this latest study, raising some minor criticisms (e.g., asking for reproducibility) but also handwaving away the overall conclusions, with no acknowledgment of the serious nature of these findings.”

    Scott links to a video clip which mentions a paper by the American Botanical Council. The non-profit ABC, which has no connection to the supplement industry, does have objections to the Canadian study:

    http://cms.herbalgram.org/press/2013/DNA_Barcoding_Critique.html

    1. Jann Bellamy says:

      “No connection to the supplement industry” ?

      The Board of the American Botanical Council has several members who are connected to the supplement and “natural products” industry via ownership of supplement companies and otherwise, as does the advisory group. These groups also include a number of “integrative medicine” proponents and naturopaths. As we know, supplements are the bread and butter of naturopathic practice and their organizations are supported by the supplement industry. The ABC’s “Adopt an Herb” program is supported by supplement and “natural products” companies.

    2. qetzal says:

      The detailed critique from Am Botanical Council is here: http://cms.herbalgram.org/heg/volume10/11November/DNAbarcodingReviewandCritique.html?t=1383684796.

      Parts of it are rather amusing, such as their outrage at Canadian authors creating their own “standard reference materials” when that term is trademarked by NIST. Or their nitpicking about the typo Plantago ovate in place of the correct Plantago ovata.

      Even better is their outrage here:

      On the scientific level, it is incomprehensible that a research group intending to identify the correct species of plant materials can confuse the scientific name that they ascribe to “feverfew,” as “Parthenium hysterophorus” (Asteraceae). However in commerce and generally in natural product research, the common name feverfew is ascribed to the scientific name Tanacetum parthenium (Asteraceae), an entirely different species.

      Amusingly, I found several sites that said Parthenium hysterophorus is the same thing as Tanacetum parthenium. There’s apparently just been disagreement over the correct taxonomic assignment. How could ABC scientists purporting to be botanical experts be unaware of that? Seems almost incomprehensible! ;-)

      All that said, I think the ABC group are correct in some fundamental critiques. I can’t see that Newmaster et al. did anything to verify that they could always detect an expected DNA barcode if it was present in a sample. For instance, they could have tried spiking the target sequence into apparently negative samples. Without that, they can’t rule out PCR inhibition from the sample. And yes, I can say from personal experience that it’s quite possible to get inhibition for one sequence while still being able to detect others, and that inhibition can vary substantially from sample to sample, &tc.

      The ABC group also argue that the way the herbals were processed could easily have eliminated all the amplifiable DNA. Newmaster argue against this by noting that most of the target ingredients could be successfully identified in a product from at least one company. That’s good to know, but it doesn’t prove that processing differences between companies are irrelevant.

      The ABC group further argue that even where there were findings of apparent contamination or substitution, it’s very difficult to know what that means. The PCR wasn’t performed quantitatively, and probably couldn’t be. In principle, it’s quite possible for a contaminant sequence to be easily amplified, while the target sequence is poorly amplified. In that case, one could easily get mostly or only amplification of the contaminant, even if it was initially present at much lower levels. I also have to agree that Newmaster et al. were seriously remiss in not discussing their PCR controls. Without some assurance there, we can’t be confident that their results aren’t affected by lab cross-contamination.

      Overall, I think Newmaster et al. is provocative and warrants follow-up. But, while I find the ABC group’s tone and much of its criticism strident and silly, I must agree that the Newmaster study is pretty flawed and shouldn’t be given too much credence (absent better corroborating data).

  2. Greg says:

    Nice of you to paint with such a wide brush. Obviously, as with any category of products, there are good manufacturers and not so good manufacturers. In Canada herbal products are now regulated through the NHP program instituted by Health Canada a few years ago. Although many at SBM may disagree, herbal medicines work, some better than others and like pharmaceuticals they don’t necessarily have the same effect for everyone.

  3. Greg says:

    hadn’t read the whole article before posting, please remove previous comment

  4. DG says:

    Well, Scott, you’ve got me concerned. I take 1/4 of a kelp supplement tablet daily to get sufficient iodine as a vegan in my diet. I do consumed iodized salt but not enough to get the recommended amount of iodine daily, and vegans have been documented in several studies to be deficient in iodine levels. I see in the study you linked to in BMC Medicine that they did not look at kelp or any other seaweed species (from what I can recognize); but this hardly gives me comfort, given the systematic problem across so many other herbal species. I have not been able to find any OTC source of iodine in an inorganic preparation such as potassium iodide that I can take. So what would you recommend I do? I suppose I could just eat seaweed, but the taste is disgusting and many seaweed cultivars are contaminated with arsenic.

    1. windriven says:

      @DG

      “the taste [of seaweed] is disgusting and many seaweed cultivars are contaminated with arsenic.”

      Go to your local Asian market and pick up a package of konbu. You can cut this into strips and cook it in soups. The taste – at least to my palate – is quite delicious. But I have no idea if konbu has the arsenic problem.

      1. Or go to any hip and guilt trippy natural food store and get yourself a package of wild Atlantic dulse, a temptation stronger than candy, delicious as can be. Costs as much as cocaine but you won’t care.

        1. windriven says:

          No $hit? Never heard of it. I’ll be in Portland this weekend and I’ll hunt some down.

          The Atlantic dulse.

          ;-)

          1. DG says:

            Heard of – and seen – dulse sold locally but never heard of konbu. I eat soup every day – would it go well with a thai butternut squash and peanut butter based soup recipe? (http://www.myrecipes.com/recipe/peanut-squash-soup-10000001134061/)

            I understand dulse can be doused on salads.

            1. windriven says:

              I’ve used konbu in a number of recipes, mostly fish or dashi based. I think the flavor of konbu would get lost in the assertive flavor of squash and peanut butter. Konbu is subtle.

            2. windriven says:

              The recipe looks terrific and I like the pairing with collards that they recommend. I’ll try it.

              1. DG says:

                It’s quite good. I’ve made it three times now. To save work, I simply buy cans of pureed butternut squash, but if you are not lazy in the kitchen, feel free to peel and dice a medium-sized squash into cubes. Also, I replaced the chicken stock with vegetable stock, and I found the cilantro to be an unnecessary touch.

        2. Birdy says:

          Dulse is $2-$3 for a big bag here in Atlantic Canada, depending on the store. Tastes great on salad and on its own.

          Where must you be to be paying that much for dulse?

          1. DevoutCatalyst says:

            Nowhere near an ocean. Birdy, maybe you could sell what you get locally online to us distant landlocked folk and turn a nice profit.

            Dulse is more than $4/oz for the brand I cited, but in fairness you won’t find any junk in their dulse, can’t recall ever biting into a seashell or pebble or hardened mass which is what the bargain brands here are chock full of. I never rinse it, it’s of a soft semi-moist consistency, I want that salty seaweed straight from the pouch ecstatic experience.

    2. goodnightirene says:

      DG, I can only add to the other suggestions by saying that I have used seaweed (in various forms including dried and powdered) in cooking and have found only the stuff I pick up on the beach to be “disgusting” and that’s probably because it wasn’t fresh. You don’t need all that much iodine–perhaps you are overdoing it with whatever seaweed products you are using, leading to the ugh response?

      @Devout

      I’ve had dulse and have no idea what you mean about the effects–not sure it was Atlantic, does it matter that much?

      1. DevoutCatalyst says:

        This is the only kind I’ve had,

        http://www.amazon.com/Maine-Coast-Vegetables-Atlantic-Vegetable/dp/B001IZIBIY/ref=sr_1_4?ie=UTF8&qid=1383855364&sr=8-4&keywords=dulse

        To me it tastes nummy straight from the bag, chewy, salty, sinful, it disappears quickly. Effects? None that I’m aware of. A bit pricey.

        1. windriven says:

          Fifty bucks for 4 ounces??? Gotta try it :-)

      2. DG says:

        Irene, on one occasion, I bought store-based seaweed (can’t remember the type) and found it revolting (both raw and cooked). Since lots of seaweed is high in arsenic, and there doesn’t seem to be much quality control, I think I will stick with very low dose kelp tablets for now, from a reputable manufacturer which states that they test their lots. Then again, I’m sure this manufacturer was involved in having products that there were tested in this study.

        I do like the taste of nori though.

        I only take a quarter of a tablet of kelp per day, which works out to around 150 micrograms of iodine per day. Most other people probably get their iodine from fish or dairy products (since iodine is used to clean the teats and milking equipment of dairy cows, some inevitably gets into milk and its byproducts).

        Another neat source for iodine is iodinated contrast dye for CT scans and the like – apparently there’s enough in a single dose to last one for two years!!

        Finally, a quarter of a teaspoon of iodized salt per day would be enough (works out to about 75 mcg of iodine), but I don’t get even that much, and processed food’s NaCl is not iodized.

    3. nancy brownlee says:

      Asian markets- and many supermarkets- sell nori, the Japanese dried seaweed. Most isn’t cooked, but there’s a toasted nori, available in packets of thin sheets, that’s very tasty.

  5. Donncha says:

    I would dearly love to see similar research done in Europe where the European Directive on Traditional Herbal Medicinal Products is in force.
    It states that products must be manufactured under a “good manufacturing practice” so supposedly it shouldn’t be possible for St John’s Wort to contain only a laxative.

    Industry had 7 years to get their affairs in order which expired in 2011 and I think I remember health food stores had leaflets warning of impending doom.
    I find it disturbing that this BBC article at the time ends with the following,

    A Department of Health spokesperson said: “We have swiftly introduced a system to register herbal practitioners using unlicensed herbal medicines, so consumers will be able to continue to use unlicensed herbal medicines if they wish.”

    1. goodnightirene says:

      The health food stores here held funerals and patrons went around with black armbands. The herb jars were draped in black and petitions were everywhere–It was a regular doom fest and that’s how we ended up with the horrible DSHEA.

      Your quote from the Beeb is indeed disturbing. :-(

    2. Pharmacist-in-Exile says:

      There is a difference between the EU directive requiring registration of herbal drugs and the regulations regarding the practice of traditional/alternative/complementary medicine. What the BBC comment is about is the latter – by registering the practitioners the UK fulfills the EU regulations and intentionally there is control systems to remove unskilled practitioners from the market in the same way as doctors can be struck off. Sadly there is often several discrepancies between the licensing of medical personnel and the registration of traditional/alternative/complementary practitioners…

      And yet we haven’t even touched upon the EU’s rules on “health claims” for foods. It is a jungle out there, and until consumers start reporting adverse effects and failure of efficacy of products with a slightly less stringent control I sadly see no aspiring dawn beyond the “healthy” shelves…

  6. Vicki says:

    Do I similarly need to worry about the contents of vitamin pills? I take 1000 IU/day of vitamin D3–or at least, that’s what I intend to take, and what the package says. I don’t think DNA barcoding would work on a simple vitamin pill.

    1. Harriet Hall says:

      Vitamins are not herbal supplements.

    2. Kathy says:

      There seems to be a drive on here (S Africa) to get rid of “straight” vitamin pills and force people to replace them with “herbal” supplements, like ginseng, seaweed, evening primrose, and a multitude of others. My local store has some 6 shelves of supplements and the last two times I went there my vitamin tabs were no longer available. There were only herbal supplements on the shelves.

      I suppose they have a higher profit margin.

    3. WilliamLawrenceUtridge says:

      Vitamins should be much easier to verify than herbal supplements, a much simpler chemical assay than a DNA barcode, but I don’t know if they have the same quality control as actual drugs. Given the fact that they can be synthesized and purified in vats rather than relying on the complicated process of growth and processing of the structurally diverse plants, I wouldn’t be surprised if vitamins were much more accurate in terms of their label versus contents. But I don’t know. Interesting question…

  7. Norma says:

    In Spain, the farmacias still sell herbs. Licor de hierbas is very popular and you can’t make it without the traditional mixes.
    Holland & Barrett in the UK sell herbal remedies. Boots, the biggest chemist sells herbal remedies and you can buy them on Amazon.
    This furore about the DSHEA came to nothing.
    However, it doesn’t seem to stop commentators in The Land of the Free from imagining that Europe is totally in the pocket of Evil Big Pharma and that your nice infusion of Tila has been banned.
    I’m much happier knowing that should I wish to buy herbal pills, then they contain what they are supposed to and aren’t adulterated or some other substance entirely.
    I don’t trust any herbs from countries with very high pollution levels. TCM? No way.

  8. Wow! This has seriously been really helpful for me especially since I am guilty on relying on herbal supplements for dieting and even constipation. Normally when you think “herbal” most people would assume that it’s safe since it’s herbal anyway. My fear though is that since I’m a tea addict is, how would we be able to differentiate or tell which ones are ideal and which ones aren’t?

  9. Christofoo says:

    I’m curious if it would be naive to suppose voluntarily USP-approved supplements would not share in the general contamination and substitution problems.
    http://www.usp.org/usp-verification-services/usp-verified-dietary-supplements/verification-process

    (Somewhat relatedly, I think it would help me as a consumer if drugs in general were labeled with a basic grade on safety and efficacy scales. Is Loratadine substantially more ethical than homeopathy (http://www.nytimes.com/2001/03/11/magazine/the-claritin-effect-prescription-for-profit.html?pagewanted=all&src=pm)?)

    Chris

    1. Christofoo says:

      (I hope I didn’t accidentally come across as an altie – I would love it if a grading scale on OTC drugs hurt herbal garbage sales, since they either would not carry the grade or score terribly. Or at least if some of them scored well, it would weed out the tolerable products (if any) from the garbage. But far more likely Big Supp would just want out of grading.)

  10. Vicki says:

    I know vitamins are not herbal supplements, but they seem to come with the same quack miranda warning–it says “bone health” in easily readable type, and then the “this statement has not been evaluated by the FDA” and the bit about not intended to diagnose or treat any disease–so I’m concerned about whether the FDA or anyone else is trying to ensure that my vitamin D pills contain vitamin D, and in the amount the package says.

    [As an editor, I also want to point out that "bone health" is not a statement, it's a noun phrase that could equally well lead to "bone health is good" or "bone health will be reduced by these tablets" or "walking is good for bone health."]

  11. Frederick says:

    Funny, all those big pharma always bring up the good’old Conspiracy theory about big pharma doing as they please. But as we can see the natural Product lobby as a long arm. The profit margin on those product most be huge, they have barely any regulation to follow, on research to pay, and they can fill the pills with grass and with 1% of active product and sell this 20% a bottle. Real drug cost like hundred and hundred ( i read somewhere in here that it average 800 millions $) in R&D ( they also spend a lot in marketing of course) and take years. it is a billions dollars racket.
    I used to take Melatonine From time to time, it was helping me get normal sleep patterns when i was working night at my last work. I sleep a lot more deeper when i use then. i use then carefully and only when really needed. But damn, Who knows what was on those pills in the end. kind of Scary

  12. Roman says:

    What about that pink and expensive Himalayan table salt. Is it superior to common iodized table salt?

    1. WilliamLawrenceUtridge says:

      It depends on what you mean by “superior”. Table salt and Himalayan rock salt are mostly just two atoms – sodium and chloride. Table salt, with iodine, is superior at preventing goiters (an iodine-deficient diet means you can’t quite acquire enough iodine atoms to complete a specific molecule found in the thyroid gland in the throat; the unfinished molecule accumulates, in vast quantities, causing the thyroid to swell dramatically). It’s also faintly bitter because of the addition of anticaking agents.

      Pink salt is 98% sodium chloride (like table salt), but it is pink because of the inclusion of iron (the same atom that makes amethyst a purple colour). Theoretically, you might get a bit more extra iron, which could be helpful if you are anemic (though you’d probably have to eat massive amounts of salt to get a meaningful quantity – I doubt it is very bioavailable). It also apparently has polyhalite (wikipedia), which has sulfur, potassium, calcium and magnesium – so good if you have a micronutrient deficiency (unlikely) but again, you’d risk hypertension if you ate enough to correct a deficiency. In essence, that pink colour is actually the systemic inclusion of contaminants, though ones that are pretty health-neutral. It’s basically dirty salt. Expensive dirty salt.

      But ultimately, bar goiters, you aren’t eating salt to correct a nutrient deficiency. Salt is a flavouring. Theoretically, someone with a trained palate might notice subtle differences between them. Once I saw an episode of Iron Chef where they used a massive block of it to dramatically present a dish – so aesthetically it does have some advantages. But when you compare strictly the atoms involved, they’re essentially 98% identical.

      So realistically – no, pink salt is not superior to table salt. Crazy claims are crazy.

    2. Chris says:

      Nah. It is just dried sea water that accumulated several millions of years ago, and then rose up when Himalayas (just like all of the salt in mountainous salt mines). Except when it got down to a high salinity it had a colony of halophilic bacteria, which are cool:
      http://blogs.scientificamerican.com/thoughtomics/2013/04/22/how-genetic-plunder-transformed-a-microbe-into-a-pink-salt-loving-scavenger/

      It is still salt, but with a couple extra minerals. Just like many sea salts, and some mined salt.

      1. Chris says:

        Bugger, I hate it when I forget important words: “when Himalayas”.. should be: “when the Himalayas rose from being seabeds to mountains.”

        But you get it. Not only is science cool, it is good for the consumer! And yes, I have fun in fancy schmancy cook shops explaining how the expensive salt became pink from salt loving bacteria. All you have to do is ask how haleophilic bacteria that create the pink color make the salt so special. Then look at the startled faces and listen to the stuttered responses.

  13. Flower says:

    Whilst I agree with the general gist of the article – herbal medicines and nutritional supplements should not be adulterated, contaminated or ingredients listed plain non-existent – since this would amount to fraudulent retail practices, I nonetheless ask: Where are the bodies? Where are the bodies, compared to the annual victims of prescription and OTC drugs?

    1. Chris says:

      Since the DSHEA stripped the FDA of oversight of those products, who counts the problems with them?

      The book Natural Causes by Dan Hurley does mention several deaths due to those products. One of those is ephedra, which caused several deaths.

      There there are those who think just because it is “natural” it is safe, and are very very wrong.

      “Where are the bodies, compared to the annual victims of prescription and OTC drugs?”

      Citation needed. Make sure it has a comparison of how many would be harmed without the medication.

      By the way, when you are checking PubMed for that citation try a search for “Laetrile cyanide.” There is more than one emergency room case report of someone taking lots of apricot seeds as some kind of “natural supplement.”

      1. Sawyer says:

        The irony with all of these “What about Big Pharma” posts is that their questions would suddenly become relevant if DSHEA was eliminated, an endeavor that they have zero interest in pursuing. I suspect there are employees for drug companies that excuse lax standards by looking at the supplement industry and thinking “Well, at least we do a better job than those guys!”

    2. weing says:

      “Where are the bodies?”
      Your local cemetery would be a good place to start, if you really want to look for them.

    3. Harriet Hall says:

      Where are the bodies? Surely you’re not suggesting we should wait for people to die before we act to ensure purity of these products.
      And if you’re going to compare harmful effects, you also need to compare proven efficacy and lives saved.

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