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We’re a drug-taking, supplement-taking nation. So how do we do so safely?

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Do you take a vitamin or dietary supplement? It’s increasingly likely that you do, as over half of all American adults took some sort of supplement over the past 30 days. Now there’s evidence to suggest that about one-third of all Americans are taking supplements and prescription drug at the same time, which is renewing questions about risks and benefits. The same study reveals that combining supplements and prescription drugs is more common among those with certain medical conditions, compared to those without.

Many of us supplement in the absence of evidence of benefit, or even medical need. For example, there is little persuasive evidence to suggest that routine supplementation with products like multivitamins is necessary. There are exceptions of course: Those potentially becoming pregnant, those on dietary restrictions (e.g., vegans), and those with demonstrable medical need are among the cases where there is a clear benefit to vitamin supplementation, for example. The majority of us take supplements, like multivitamins, for “insurance” rather than because we have a deficiency or medical need. The evidence for non-vitamin supplements, like herbal products, is just as questionable as it is for vitamins, with few products showing meaningful health benefits. Ultimately decisions about supplements come down to evaluations of risk and benefits. Since I started working as a pharmacist, I’ve always cautioned consumers about the quality concerns and efficacy with herbal products and supplements, and the resultant risks that make me very hesitant to suggest their routine use – especially when they’re combined with prescription drugs. Yet the evidence suggests that it’s occurring – with increasing frequency.

The supplement trend

I’ve covered this in a past post, but it’s worth reflecting on the growing habit of consuming dietary supplements – 40 years of data from the National Health and Nutrition Examination Survey (NHANES) shows a doubling of use since the 1970′s:

Source: Council for Responsible Nutrition

Source: Council for Responsible Nutrition

With these numbers, it should be no surprise that supplements are now big business: this is a $30-billion-per-year (USD, 2011) industry with little regulatory oversight. The current marketplace is now rife with exaggerated claims and few products backed by credible evidence. And importantly, dietary supplements are not held and inspected to the same manufacturing and quality standards as pharmaceutical drugs – so there are persistent and worrying questions about the quality of products sold as supplements.

The quality question

Surveys suggest the vast majority of Americans are confident in the safety, quality, and effectiveness of these products. Is that fair? I have noted before that the absence of good product quality standards for dietary supplements is a persistent barrier to the use in science-based ways. Drugs have a rigorous standard that requires the products sold to be equivalent to the versions studied in clinical trials. With supplements, there is no similar quality standard. Weaker regulations and weaker standards mean less confidence for health professionals (and consumers) that what’s on the label is actually in the bottle.

The lack of confidence in quality seems justified. I recently described a disturbing study that suggested that in a sample of 44 supplements purchased off-the-shelf, only 48% were authentic and 59% of products contained species not listed on the label. Only two of the 12 companies in the sample had products without any substitution, contaminants and fillers.

The contamination concerns are among the most concerning – from lead in Ayurvedic remedies to shark cartilage supplements that contain mercury and neurotoxins and ironically, supplements contaminated with actual drugs. As long as there are poor quality standards, it’s difficult to see how supplements can be used safely in combination with prescription drugs, where an unlabelled ingredient could cause unanticipated harm.

The study

In light of the demonstrable quality problems with supplements, combining supplements and prescription drugs raises questions about safety. This new analysis, titled “Concomitant Dietary Supplement and Prescription Medication Use Is Prevalent among US Adults with Doctor-Informed Medical Conditions”, was published in the Journal of Academy of Nutrition and Dietetics in April 2014. The data comes from the NHANES database, which is supposed to be representative of your typical civilian, non-institutionalized adults. This survey excluded all pregnant women and participants were information was missing. The sample size was almost 10,000 adults.

NHANES assessed supplement use through personal interviews. Supplements were divided into 18 categories of products. Interestingly, multivitamins were divided into “standard” multivitamins (no minerals/botanicals) versus other forms of multivitamins, some of which also contained herbals. This makes sense, as there’s a big difference in ingredients between a cheap drugstore multivitamin and something like this which claims to be a detoxifying multivitamin. Prescription medication use was evaluated using the same process, as well as any “doctor informed medical conditions” (DIMC) which included:

  • asthma
  • arthritis
  • congestive heart failure
  • coronary heart disease
  • angina
  • angian pectoris
  • heart attack
  • stroke
  • high blood pressure
  • high cholesterol
  • emphysema
  • chronic bronchitis
  • any liver condition
  • thyroid problem
  • cancer
  • kidney dysfunction/dialysis
  • osteoporosis

Both the term DIMC and the list of chronic illnesses included under this label seem to have been made up solely for this study – I could not find any other mention of it. Having said that, it is a reasonably good list of chronic medical conditions that require medical management and supervision.

The results

Those that used supplements and prescription drugs tended to be females >60 years old, college graduates, and hold higher income levels, which is consistent with what we’d expect with supplement users. Half of all adults used supplements, and more than half reported prescription drug use. And one third reported simultaneous supplement and prescription drug use. This would mean approximately 72 million Americans are taking prescription drugs and supplements together. The use of supplements or prescription drugs was higher among those with a DIMC – specifically osteoporosis, where almost everyone surveyed was taking supplements and prescription drugs:

Table 2

Supplement use in oseteoporosis is not surprising, as the researchers categorized calcium as a “drug” if it was prescribed but as a “supplement” if it was purchased directly by the consumer without a prescription. A closer look at the supplements being used reveals some interesting data:

Figure 2

Notice how multivitamins and their variants make up the vast majority of supplement use. “Multivitamin plus other” (at least 3 vitamins and at least one other ingredient, but not a botanical) is the most prevalent, followed by antacids, and then multivitamin/botanical combinations. The use of products like single-ingredient botanicals was actually small – less than 1% of consumers. Looking at the relationship the other way, those taking cardiovascular drugs were the most likely to also be taking supplements, followed by those on central nervous system agents, then hormones, and so on:

Figure 2-2

What this study tells me is that the most common supplement that’s combined with a prescription drug is usually a vitamin – but that vitamin may contain ingredients that go beyond the usual basic multi. (This isn’t the first survey that shows multivitamin use dominates supplement use.) The combination of botanicals into multi-vitamins is concerning, as it’s botanicals like herbs that can induce or impair liver enzymes and have dramatic effects on prescription drugs. Supplements like St. John’s Wort are the bane of pharmacists as they can cause an array of significant and severe drug interactions.

Conclusion

The concurrent use of supplements and prescription drugs is very common, even among those with major medical conditions. Yet there is limited data to suggest that supplements offer meaningful health benefits. Given the uncertain and unreliable quality of dietary supplements that are currently marketed, the risks and benefits of combining supplements with prescription drugs are not clear. Not only are there the potential harms from adverse effects from supplements, there is the additional risk of supplements interacting or interfering with the effectiveness of prescription drugs. Both consumers and health professionals need to understand that the decision to take supplements should not be made lightly – they may not be innocuous, and they may antagonize the effects of any concurrent prescription drugs. And even a multivitamin may contain ingredients that can antagonize medication. The exploding sales and use of supplements may be good business but the health effects are less clear. Mixing supplements and drugs is a type of health roulette – you simply can’t predict the effects.

Reference

Farina E.K., Austin K.G. & Lieberman H.R. (2014). Concomitant Dietary Supplement and Prescription Medication Use Is Prevalent among US Adults with Doctor-Informed Medical Conditions, Journal of the Academy of Nutrition and Dietetics, DOI:

Photo from flickr user j.towbin © used under a CC licence.

Posted in: Herbs & Supplements, Pharmaceuticals

Leave a Comment (93) ↓

93 thoughts on “We’re a drug-taking, supplement-taking nation. So how do we do so safely?

  1. Guy Chapman says:

    Obviously supplements are safe, because natural! Oh, wait…

    So, how likely is it that the vitamin industry’ DSHEA could be repealed? It us important that the FDA is given oversight, I think.

    1. goodnightirene says:

      It is important that the FDA is given oversight, I think.

      I agree. But how? Misinformation is so deeply entrenched at this point, significant harm would have to occur to get anyone in power to notice.

      Part of me says to let the demographic that sucks up supplements go on their merry way wasting their money, since they have more money than sense.

      1. Nutritionprof says:

        Living proof of evolution, perhaps?

    2. Greg says:

      Yesterday I was counting the number of pharmacies in my neighborhood – at least 10 within a five minute drive. What is so wrong with us that there’s a drug store on practically every corner?

      And given that there are so many drug stores, is it any wonder that people will also take natural supplements indiscriminately? It would seem that taking health supplements of one kind or another is normal these days.

      1. Windriven says:

        And not just pharmacies. In the Vancouver, WA area one of the supplement houses (GNC, I think) just built a huge store at a busy intersection. One has to sell a lot of ginkgo biloba to pay for that kind of real estate.

        1. Calli Arcale says:

          Well, don’t forget that drug stores are a lot more than just pharmacies. Apart from the health care stuff they offer, they straddle the line between discount store and convenience store. Most also offer photo processing, printing, a limited grocery selection, some apparel, basic sundries such as paper towels and plates, cheap gift items, greeting cards, cleaning products, blank media, snack food, and so on. A 24-hour Walgreens saved the first Christmas party I ever hosted, because it was the only place open that day that carried both plastic cups and heavy cream. ;-)

          1. Woo Fighter says:

            Photo processing? Is that still a thing?

            I thought that was in the same category as typewriter ribbons…or videocassettes…

            1. Peter B says:

              Photo processing is now mostly prints from digital images.

          2. Frederick says:

            Oh! Don’t forget the high quality chocolate! that’s the most important stuff my drug store sell… throw all the pills in the garbage chocolate can cure everything :-)

            1. irenegoodnight says:

              Ha! Walgreen’s only carries cheap and some mid level chocolate, but no really good stuff–alas. One more reason that I should have emigrated long ago.

              Yes, chocolate cures everything–except obesity :-)

          3. MTDoc says:

            Sorry, I just have to tell you about what one of our local pharmacies sold as his sideline. He was also the franchised state liqueur store. I always regarded it as at least an honest enterprise, as he made no attempt to claim unwarranted benefits from the products that constituted his profit center. The sad fact is that a pharmacist can not make a living in most places as a private pharmacy without some sideline. Most pharmacists are employees, and although they for the most part are professional, they work for and employer, not necessarily for you.

    3. stanmrak says:

      Be careful about who you depend on for oversight. I would not recommend the FDA. They are primarily interested in profit for their overseers, not safety for the consumer.

      http://www.jsonline.com/watchdog/watchdogreports/fda-oks-high-dose-narcotic-painkiller-zohydro-raising-abuse-concerns-b99128369z1-229484621.html

      http://truth-out.org/news/item/10524-former-fda-reviewer-speaks-out-about-intimidation-retaliation-and-marginalizing-of-safety

      You’ll have better odds by buying your supplements from companies that have established a good reputation for quality, rather than counting on the government. It’s not that hard to find them, but people are reluctant to pay the higher price so they buy the junk products in their supermarket thinking they’ll get the same results. There is a difference.

      1. WilliamLawrenceUtridge says:

        So…we’re supposed to trust the supplement companies to self-police, not even as an industry but on a per-company basis? When has that ever worked?

        And the FDA is corrupt, serving only their corporate overlords…so basically what you are saying is the DSHEA, with its complete lax set of standards for safety and efficacy, is already in place for actual drugs.

        Why your response is not “appropriately fund the FDA and support its mandate to undertake responsible and effective actions to protect citizens” I’ll never understand. Why your response is “just trust these multi-billion dollar companies” is totally incomprehensible to me. Particularly given your rants about industry and government corruption.

        And why you think these supplements are harm-free and effective, based apparently purely on the word of people like Joe Mercola and Gary Null who sell, endorse and otherwise profit from them, I’ll also never understand.

        It’s as if you only think drug companies can be greedy, and any other company is pure and untainted as driven snow.

        1. Calli Arcale says:

          Plus, of course, a lot of the supplement manufacturers are also Big Pharma manufacturers. Why are they evil money-grubbing lobbyists when they’re selling FDA-approved pharmaceuticals, but able to be taken at their word when they’re selling supplements?

          I suppose stanmrak would say that they don’t have a good reputation, but I think he’ll find quite the opposite. After all, they spend an enormous amount of money building and maintaining their reputation. People trust Johnson & Johnson on products ranging from aromatherapy baby wash to Band-Aids to all-natural moisturizers to tooth brushes to pharmaceuticaul flagship Tylenol. They are very widely trusted. stanmrak, you do realize, don’t you, that your strategy would come as a godsend to the big pharmaceutical companies?

          1. stanmrak says:

            J & J may be widely trusted by people who haven’t looked into them. They’re not. NEVER buy supplements made by a pharmaceutical company, Basic Rule Number 1. NONE of their supplements are any good; that’s one reason why they’re used in most of the studies.

            1. Windriven says:

              “NEVER buy supplements made by a pharmaceutical company, Basic Rule Number 1. NONE of their supplements are any good; that’s one reason why they’re used in most of the studies.”

              What specifically is wrong with them, stan. And please provide reliable citations to back your allegations.

              1. stanmrak says:

                Basically, they use cheap ingredients and insufficient dosages to make them inexpensive so that they’re not effective. There’s no mystery to it. When a product costs less than 10 percent of the price of a quality competitor, I would be presume that product was no good.

                Most quality supplements are USP Verified. USP Verified dietary supplements have been voluntarily submitted to the USP Dietary Supplement Verification Program and have successfully met the program’s stringent testing and auditing criteria.

                http://www.usp.org/usp-verification-services/usp-verified-dietary-supplements

              2. Windriven says:

                So… J&J is out but Costco is in?

              3. WilliamLawrenceUtridge says:

                When a product costs less than 10 percent of the price of a quality competitor, I would be presume that product was no good.

                And when comparing generic pharmaceuticals to name-brand competition, you’d be wrong. And you can test this, by reviewing the quantity of the active ingredient on a per-weight basis. Not to mention quality control in the extraction, distillation, packaging and other measures to ensure the batch-to-batch consistency of a specific molecule, which has been demonstrated safe and effective in clinical trials.

                None of which occurs with supplements or in particular herbal products.

                Your recommendation to look for USP Verified products is also questionable – it may guarantee that a specific herb is present. It does not verify the growing conditions, the concentration and dosage of specific molecules, and in particular the safety and efficacy of said molecules. And, of course, for vitamins and minerals you’re just adding to the expense since for them a molecule is a molecule is a molecule. Get the cheap stuff, it’ll do just fine. Or, even better, get your vitamins from food.

          2. stanmrak says:

            OK, J&J has a great reputation for Q-tips, but not nutritional supplements – or even customer safety. Have they taken that talc out of their baby powder yet?

            “Based on limited evidence from human studies, the International Agency for Research on Cancer (IARC) classifies the perineal (genital) use of talc-based body powder as “possibly carcinogenic to humans”.”

            http://www.cancer.org/cancer/cancercauses/othercarcinogens/athome/talcum-powder-and-cancer

            1. Angora Rabbit says:

              I am someone who personally knows and has worked with nutritional scientists at J&J. Outstanding nutrition research, solid science. You are talking out of your tinhat again.

              The reality is that nearly ALL micronutrients are manufactured and supplied, under GMP, by just four companies. BASF, Roche, Ciba-Geigy, and I’ve forgotten the fourth. “The good stuff” you are whinging about originates from those same manufacturers. Known QC, purity and content. Everyone relabels it under their own house brand. Indeed, if they didn’t come from those four, I’d be worried about what was in that tablet or capsule or gummy.

              1. Windriven says:

                stan is a master of innuendo. Note how he structures his comment:

                “OK, J&J has a great reputation for Q-tips, but not nutritional supplements”

                Start with faint praise and finish with an unsubstantiated slam. The reader thinks, ‘oh, he must be telling the truth because he does praise them for this one thing but calls them out on their failings in the second.’

                Slimy. But effective.

              2. stanmrak says:

                Maybe the supplements sold in drug stores are all made by these 4 companies – but those aren’t the brands I’m talking about. The best supplement manufacturers all make their own products. You won’t find them in most grocery or drug stores.

              3. Harriet Hall says:

                Please enlighten us. List the best manufacturers and explain how you know they are the best.

              4. Windriven says:

                stan, you missed Angora’s point entirely.

                The pills get made from component ingredients. Those active ingredients are made by just a handful of companies. Is it your delusion that EarthMother brand B12 tablets grows its own vitamin B12 trees – tended by Mother herself, grinds the roots and berries, winnows out the sticks and leaves, and passes it along to USP for verification?

                Or does Mother pick up the phone and call BASF for a ton of high purity, quality controlled, cyanocobalamin powder?

                Oh Mother, I’m soooo disappointed!

              5. Sawyer says:

                Now I wonder if Stan is buying his “supplements” from a guy in a dark alley at 2 am. I suppose that would be one way to guarantee they didn’t go through any of the quality control measures that large companies employ.

                It would explain a lot of his posts…

              6. MadisonMD says:

                Now I wonder if Stan is buying his “supplements” from a guy in a dark alley at 2 am.

                No, it is delivered by aliens. But he can only see them when he is plugged into the ground of a wallsocket.

            2. WilliamLawrenceUtridge says:

              OK, J&J has a great reputation for Q-tips, but not nutritional supplements – or even customer safety. Have they taken that talc out of their baby powder yet?

              Um…so what? That’s rather not the point – the point is that what it says on the container is what is actually in the bottle, and it is indeed useful for what it is described as being useful for – reducing friction and drying areas.

              Also, did you note the rest of the page you link to? Because it discusses the highly equivocal nature of the scientific research, findings so equivocal and questionable that they’re not even sure it exists (and many studies showing no increased risk).

              I also like how you use the word “baby powder” instead of “talcum powder”, presumably to make us worry about babies being exposed when the discussion makes it clear it’s talking about adult women, sanitary napkins, diaphragms and condoms. The word “baby” only appears once, referring to “baby powder”; at no point does the page suggest that talcum powder is a cancer risk for infants.

        2. Frederick says:

          People like him always baffle me, there arguments are such a bad, and blinded double standard. No company is to be trusted if they don’t have a strong regulation. And beside, how many supplement company are own ( or partly owned) by the sames company they think are evil or chemical company.

          1. ebohlman says:

            It’s simple tribalism. I call it “who-think” as compared to “what-think”. Quite simply, if it (which could be either a physical object like a drug/supplement or an idea) comes from someone he approves of, it’s good; if it comes from someone he disapproves of, it’s bad. The approval/disapproval is based on the ability to make an emotional connection, not on any empirical considerations regarding “it”.

            We all need to do this to some extent simply to avoid cognitive overload, but some take it too far.

            Also, there’s the tendency of conspiracy theorists (and I’ve come to think of it as the defining trait of one) to explain gaps in their own knowledge as the result of suppression or manipulation rather than their own lack of effort in trying to fill them.

        3. stanmrak says:

          Giving the FDA more money wouldn’t solve anything as long as there’s a revolving-door policy between the FDA and Big Pharma.

          1. irenegoodnight says:

            Excuse me Stan, but “BigPharma” has kept me alive past an age when all my forebears were dead from early onset heart disease. Big, bad, pharma gets all of $10 or $20 a month from me for generics that have few, if any, negative side effects.

            There is work to be done in the pharmaceutical business, but the problem is too little power for the FDA, not too much.

            Do you ever ask yourself WHY you believe these memes about things? Who tells you this rubbish? Why do you decide to believe them instead of the collective body of scientific knowledge?

          2. Windriven says:

            “Giving the FDA more money wouldn’t solve anything as long as there’s a revolving-door policy between the FDA and Big Pharma.”

            So stan, your thought is that freshly minted PhDs can either go to work for a pharmaceutical company or for FDA and once the path is chosen, the die is cast.

            You have kind of a fascist streak going there, huh? And where do you draw the “pharma” line? If I work in a university genomics lab that gets part of its funding from, dare I utter its name?, GlaxoSmithKline, does that count? How about if I accepted a GSK tote bag at a conference?

            Implicit in your statement is the belief that people can’t rise above their self interest. It is true that some can’t and it is fair to penalize them harshly when they betray the public trust. But to ban any cross-pollination between industry and regulatory bodies is bad for both and ultimately, I think, bad for consumers.

            1. CHotel says:

              I know that I make recommendations to physicians exclusively from the company whose logo is on the pen I am currently using.

              (Jokes, for anyone too thick to realize it)

              1. Windriven says:

                You’re obviously a tool of the Pharmco-Industrial complex!

  2. Jeff says:

    Sometimes prescription drugs and supplements are taken together to address a rarely-discussed problem: Drug-induced nutrient deficiency.

    http://www.chiro.org/nutrition/ABSTRACTS/Nutrient_Depletion.shtml

    One pharmacist has written a book about the subject:

    http://www.amazon.com/Drug-Muggers-Medications-Essential-Nutrients–/dp/1605294160/ref=sr_1_1?ie=UTF8&qid=1399554382&sr=8-1&keywords=drug+muggers

    1. Calli Arcale says:

      Rarely discussed? Drugs that cause nutritional deficiencies are packaged with instructions to supplement as needed. Most drugs do not cause nutrient deficiencies, though, so it’s not something that usually needs to come up. More common is for diet to make the drug less effective. For instance, grapefruit interacts with a lot of drugs. And you shouldn’t take calcium supplements or calcium-containing foods close in time to when you take certain antibiotics, such as Cipro, because the calcium binds to them and makes them less effective. This is all stuff the pharmacist should be going over you when you get your prescription.

      1. n brownlee says:

        I dunno, Calli- I get a huge honking 40 ml depot shot of Sandostatin every 28 days and although the drug has the perfectly well known, well documented action of binding with fat soluble vitamins and causing deficiency, none of my several doctors have ever mentioned it to ME. Nor have any of them ever brought up the also perfectly well known, well documented action of my neuroendocrine tumor (carcinoid) secretion of serotonin causing me to be deficient in niacin.

        I consider it to be my responsibility to find this stuff out. Good thing I do, huh?

      2. Bianca says:

        Really? Because nobody told me that Nexium could cause nutrient deficiencies. The doctor didn’t tell me, the pharmacist didn’t tell me, the monograph from the pharmacy didn’t tell me, and even the package insert didn’t tell me.

        1. weing says:

          “The doctor didn’t tell me, the pharmacist didn’t tell me, the monograph from the pharmacy didn’t tell me, and even the package insert didn’t tell me.”
          I don’t believe you. The package insert for your reading is here

          1. Windriven says:

            @weing

            I didn’t believe her either. But I read through the insert that you linked and, while I found prominent mention of hypomagnesemia, I didn’t find any mention of other possible nutritional deficiencies. Perhaps there aren’t any. I poked around but I certainly didn’t do an exhaustive search but all I came up with from a reputable source was a case report of B12 deficiency with a suggested link to a proton pump inhibitor. The physician’s page for Nexium didn’t offer anything more. Am I safe to conclude that hypomagnesemia is the only significant nutrient deficiency causally linked to PPIs?

            1. weing says:

              “Am I safe to conclude that hypomagnesemia is the only significant nutrient deficiency causally linked to PPIs?”

              That and decreased calcium absorption leading to osteoporosis. These are not usually clinically significant with short term use of the drug. Long term use is a different matter.

            2. mouse says:

              Actually, I think long term PPI use can cause B12 and iron (?) deficiencies, through malabsorption. I read that while looking up info on h pylori and gastritis (my other thing). I don’t see that in the warning. Am I missing it?

              I think I can track down the article, if someone wants a citation.

              1. weing says:

                The atrophic gastritis mentioned is associated with B12 malabsorption. Lack of gastric acid leads to decreased absorption of iron salts, etc.

              2. MTDoc says:

                I am on long term PPIs, and as such was concerned about B12 absorption, in as much as pernicious anemia is associated with a failure of the parietal cells in the stomach to produce intrinsic factor. What I gleaned from my search is that the PPIs block the parietal cells from producing acid (HCL), but not intrinsic factor. Pernicious anemia results from the death of parietal cells, but PPIs only inhibit their acid producing function, it does not kill them. I have been on PPIs for 15 years, and have not developed PA yet.

                As for concern about too much B12, the old time docs (before my time even) used to give B12 shots on a regular basis to patients who insisted they made them feel better. This was in fact the classic placebo.

                Sublingual B12 tabs can be found at Costco, if you really need to find them. They actually taste good (grape). The idea behind dissolving them under your tongue is that they are absorbed directly into the blood stream, hence do not need intrinsic factor to enable absorption. I’m really not sure that is true, just stating the theory behind it.

                The take home here is that long term use of PPIs does not automatically lead to B12 deficiency.

              3. CHotel says:

                Anything requiring an acidic environment for absorption could be decreased through PPI or H2RA use for sure. I once diagnosed (read: guessed and turned out to maybe have been right about) a friend’s vertigo as being linked to hypomagnesia through her use of Losec.

                @MTDoc

                The surprising thing is that several trials have showed oral B12 supplements to be superior to the injections (in terms of blood levels at least, not sure of the clinical significance)

              4. WilliamLawrenceUtridge says:

                @MTDoc

                I looked into the sublingual versus swallowed a while back. Apparently there is no difference, you don’t absorb through your tongue, the pill dissolves and you swallow the results anyway:

                http://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/

          2. stanmrak says:

            Geez – an eleven-page disclosure, in fine print!

            How could anyone ever suspect that a drug that shuts down your digestive system around the clock could harm you?

            1. weing says:

              “How could anyone ever suspect that a drug that shuts down your digestive system around the clock could harm you?”
              Not really true. It shuts down acid production. That has its benefits in certain conditions. There is always a downside.
              It’s always a matter of risks vs benefits. That’s the art of medicine.

  3. Yodel lady says:

    Thank you for posting this! I’ve always wondered just how they define “supplements” when alt-promoters claim there’s such a huge demand for them.

    I take a multivitamin because a medical condition limits the foods I can eat, and my science-based PCP insists I take a calcium supplement and Vitamin D because I have ostopenia. I do not feel this makes me an altie and have always bristled at the broad-brush statistics that throw me in the same boat with people who are popping magic pills all day long. It bothers me a great deal that the chaos in the supplement industry prevents me from knowing the purity of the few supplements I do need to take.

    The alt-med people who use these statistics to claim popular demand sure seem to be stretching the limits of reality.

    1. Greg says:

      I think any product that is standardized and adheres to GMP (Good Manufacturing Practise) is going to be of reasonably good quality & purity.

      1. Yodel lady says:

        Greg, as I understand it Good Manufacturing Practices apply to pharmaceuticals, not supplements. The supplement makers can do as they like unless they happen to get caught.

        http://www.fda.gov/drugs/developmentapprovalprocess/manufacturing/ucm169105.htm

        1. Greg says:

          In Canada, natural health products must adhere to GMP in order to be licensed for sale. http://www.hc-sc.gc.ca/dhp-mps/prodnatur/about-apropos/index-eng.php I thought perhaps some of that has spilled over into the US, at least for supps coming from Canada.

          1. stanmrak says:

            In the US, manufacturers can voluntarily submit their products to the USP Dietary Supplement Verification Program. The program was established to help dietary supplement manufacturers ensure the production of quality products for consumers. When you buy supplements, look for the USP label. Most reputable supplement companies do this – they know discriminating buyers look for it, and it’s good for their business.

            1. WilliamLawrenceUtridge says:

              can voluntarily submit

              For drugs, this is not voluntary. If the FDA had more resources, and there were adequate support from the government, this could be extended to supplements, and it would be a good thing. But then the FDA would be more powerful, and presumably could buy both black helicopters for confiscating supplements and tinfoil-piercing mind-control rays. Or possibly solid-fluoride nanobots? To…decrease the population? For reasons unknown?

          2. Frederick says:

            Keep in mind that, if im not mistaken, the study cited in this article (there’s was also a review of this study couple of months ago here too), the one that said 48% of tested supplement had problems, was Canadian, made in Ontario, so no, regulations are as poor on our side of the fence, heath canada are as wusses as the fda o supplements.

        2. Ekko says:

          Dietary supplements in the US also must be made under GMP. As much as I love SBM generally, misinformation and attempts to smear an entire industry based on a few bad apples is a disservice and inaccurate:
          http://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/DietarySupplements/ucm238182.htm

          There are bad apples and quality control issues when it comes to pharmaceutical manufacturing as well, but this doesn’t represent the whole either.

          1. weing says:

            “Dietary supplements in the US also must be made under GMP”

            Just under the title of the link you entered is this line:
            “Contains Nonbinding Recommendations”

            That means buyer beware. With pharmaceuticals at least they are binding.

  4. mouse says:

    Interesting and kinda distressing article. I wish there were better controls and directions with supplements. I wish that my doctors offered more advice, information about supplements. I seem to get reactions on a spectrum between vague and negative.

    I’ve had mild anemia for a couple of years along with bouts of fatigue, unidentified shortness of breath (outside of my asthma) along with some other wacky symptoms like intermittent prickling or burning skin. Between peri-menopause, cervical nerve root compression, an anxiety disorder and an unidentified possible connective tissue diagnoses it all kinda hard to figure out.

    When the anemia showed up on my blood test, my previous doctor was insistent that it was so mild that it couldn’t be the cause of my fatigue. She also said that the results ruled out b12 deficiency (normal MCV, I guess) which I was concerned about because my dad had pernicious anemia and sometimes the way I forget things and can’t recall words is just like him. She wasn’t really interested in figuring out the anemia. I guess because it was so mild.

    My newer doctor decided to test for iron and b12 deficiency, although there had been basically no change in my test results. When the nurse call with the results she said that the low ferritin level (9 with a normal of 12 – 200ish) indicated iron deficiency. I’ve been feeling kinda cruddy lastly, so I was hoping the doctor would help. But then at the follow up appointment the doctor said – no iron deficiency, because my other iron values were normal. The nurse mentioned that my b12 was low normal and that could mean a deficiency. The doctor didn’t mention it until I asked, then just off handedly said “take a b12 supplement, make sure it dissolves under the tongue” then moved on. I wish I was better at slowing down appointments and asking questions, but I have kinda a turtle brain in a bunny world.

    When I looked up low ferritin online I see (from medical sites, not CAM sites) that it’s pretty much diagnostic of iron deficiency. What’s up with that? When I went to the drugstore to buy dissolve under the tongue B12 supplements, oh my lord! What confusion. Which ones dissolve under the tongue, what dosage, are they safe? I get very easily confused with these sorts of things. But I did figure it out (I think), although it took me awhile. I also bought and started taking iron supplements. Because, what the heck, I just want to feel better- my doctors don’t seem very engaged on the issue and this is about my only clue*. I have figured out that I have to take them at intervals, so the everything absorbs properly.

    I’m not sure what we are supposed to do as consumers. My doctors aren’t interested and I don’t have the energy to find one who is. The government isn’t interested. It’d be nice if you could just get all the nutrition from food, but that doesn’t always work out.

    Sorry guys, that was really long.

    *Although – maybe I’m wrong and the doctors are right when they seem to think I’m making a mountain out of a mole hill. I don’t know. I have completely lost perspective.

    1. weing says:

      “The nurse mentioned that my b12 was low normal and that could mean a deficiency.”

      These tests are not that reliable. Check a methylmalonic acid level and if high it would mean B12 deficiency even with normal B12 blood levels.
      http://www.nejm.org/doi/full/10.1056/NEJMcp1113996

      1. mouse says:

        weing – Thanks – That is probably what the nurse meant when she suggested the doctor might want to do more tests. But I guess she (my doctor) didn’t. She just suggested the B12 supplement. I could suggest the test, but it seems like doctors are not so happy with patients requesting tests, understandably in many cases. I kinda was hoping for a doctor who would just order that stuff without my asking for it*. Do you happen to have a clone living in Michigan?

        * I’m beginning to think that finding a doctor is worse than dating…kinda like “I just want a man who brings me flowers without my asking”, but with blood tests instead.

        1. Kathleen says:

          Sorry Mouse about the issues you had. Similar issue here and I finally found an internist that is trying to figure things out. I know the feeling about making a mountain out of a mole hill though. I am now on 4 different supplements and I can only hope they are decent quality.

          1. mouse says:

            Thanks! and glad you found a good internist.

    2. CHotel says:

      The Pharmacist at your drug store should be able to guide you through selecting the best dose and dosage form of any supplement you might need, and point out which brands are more reputable than others. It’s always easier for us when the MD has mentioned a dose, but even without that it isn’t an issue. [/profession plug]

    3. WilliamLawrenceUtridge says:

      See my comment here, sublingual is not really supported as better than simply swallowed.

      1. mouse says:

        WLU – But my doctor said it should dissolves under the tongue. You aren’t suggesting that you know more than the doctor…are you? ;)

        At this point the advantage to the sublingual is that it’s in my cabinet and it’s a pretty pleasant cherry flavor (unlike cough syrup which is an unpleasant cherry flavor). Price seems to be about the same.

        1. WilliamLawrenceUtridge says:

          Never! Only that I reviewed the NIH report on B12 recently, and she probably has not – and the people who put together the NIH report probably know more than your doctor :)

          I’m not saying throw it out – I’m saying that according to the NIH, you get just as much benefit from swallowing the tablet as you do from letting it dissolve. So if you want to treat it as a breath mint, it’s not a problem, but if you are in a hurry and want to just get on with your day, swallowing it is fine too.

  5. Tazia Stagg says:

    Who is working on updating DSHEA?
    I’d like to help.

    1. Jann Bellamy says:

      I don’t know if there is a group specifically organized to amend DSHEA. You can help by letting your Senators and Representative in Congress about your concerns and keep bugging them about it. Sen. Dick Durbin has tried to get reasonable legislation passed amending DSHEA but it generally goes nowhere: http://www.sciencebasedmedicine.org/big-supp-resists-giving-consumers-safety-and-effectiveness-information/. Big Supp and the “health freedom” crowd battle any attempts to reform DSHEA, and they have some powerful Senators in their corner: Harkin (who is retiring) and Hatch.

    2. Jeff says:

      One way to crack down on those selling illegal products would be passage of The Designer Anabolic Steroid Control Act of 2014:

      http://www.nutraingredients-usa.com/Regulation/An-important-step-Trade-associations-and-USADA-welcome-new-Designer-Anabolic-Steroid-Control-Act

  6. stanmrak says:

    If the issue is safety; well, almost no one has ever died from taking a supplement. Prescription drugs kill hundreds of thousands of users every year. There’s your safety issue.

    1. Nutritionprof says:

      There isn’t a place for folks to report adverse supplement effects to-except perhaps the supplement maker. And no one makes those folks do anything with the information
      I’m afraid when it comes to supplement regulation -the fox is guarding the henhouse

    2. MadisonMD says:

      almost no one has ever died from taking a supplement

      Almost, hey? How many die from supplements, Stan? How many are harmed? How do you know the numbers if they are not tracked or measured? In your putative numbers, do you include liver damage, increased cancer risk and death?

    3. irenegoodnight says:

      Are you including people who use supplements to treat, say, high blood pressure, and then have a stroke or heart attack? Why do you suppose that we are now living longer than ever before, eh?

    4. WilliamLawrenceUtridge says:

      If the issue is safety; well, almost no one has ever died from taking a supplement.

      Two points:

      1) Gary Null almost did (my Dog that picture is creepy, that man needs corrective eye surgery)

      2) If you’re talking about acute deaths, then you’re not quite right. In 2012 there was 1 death due to yohimbe, 1 due to a homeopathic agent (presumably drowning?), 2 due to calcium, 1 due to magnesium, 1 due to multivitamin and 1 due to B complex. So not many, but some. If you’re talking chronic vitamin use, well, that’s far more complicated. There is definite evidence that taking high-dose vitamin and mineral supplements increase all-cause mortality in many groups, through mechanisms unknown. Since the mechanism is not known, we can never know how many people die because of “vitamin insurance” rather than getting their vitamins through food.

      Prescription drugs kill hundreds of thousands of users every year. There’s your safety issue.

      There’s a totally unrelated safety issue. You make it sound like we can’t recognize the dangers of vitamins, minerals and supplements until nobody dies of prescription drug problems. That’s stupid. If vitamins cause an even tiny increase in deaths, we can still address this even if drugs cause more. Particularly given how many people seem to be taking totally unnecessary vitamins in the name of “insurance”, or “GMO” or “soil depletion”, none of which are actual reasons to take a vitamin.

      There are myriad safety issues that can be addressed – everything from playground equipment to firearms. You don’t have to wait until one is perfect in order to improve the other. With supplements, we could start by recognizing that non-vitamin, non-mineral supplements are generally useless and of uncertain purity and contents. For vitamins and minerals, we could recognize that there do seem to be small risks, but most are simply unnecessary.

  7. Jeff says:

    @Yodel lady: The FDA has devised a set of GMPs which all supplement makers are required to follow:
    http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfCFR/CFRSearch.cfm?CFRPart=111

    @Nutritionprof: The FDA’s Medwatch form can be used for all products regulated by the agency, including dietary supplements:
    https://www.accessdata.fda.gov/scripts/medwatch/

    Since 2008, supplement companies have been required by law to report all serious adverse events relating to their products.

  8. Vicki says:

    I suspect that a lot of the “other” in “multivitamin+other” is iron, which seems to be the default in vitamins for premenopausal women. I suspect there’s no way to go from this dataset to determine what percentage of “multivitamin+other” does not contain either iron or calcium, but that’s just idle curiosity: I’m not sure what could be done with the information even if it was available.

    But I distract myself. I was looking for an answer to the question in the article headline. Given that my doctor has me taking both prescription medication and a vitamin D supplement, how do I select a good supplement? (I will assume I can trust my doctor and pharmacist that the drugs get along with each other and with the vitamin.)

  9. Jeff says:

    Unless one is brain dead or lives in cave, be advised that things have changed on planet Earth. Even an idiot would get that you can’t expect the nutrient levels in our foods to magically sustain themselves over thousands of years via farming. Hence the NEED for some method to restore nutritional deficiencies. The MD’s got us all used to taking a pill for just about everything so why not supplements?

    I practice in Chicago and interviewed to be the first Chiropractor at Northwestern Hospital. Their interest in me was predicated on my unique approach to restoring health WITHOUT medication. In the last interview we all realized this was a poor fit. As long as the medical profession can continue to dupe the fat, stupid recalcitrant public into doing nothing to restore their own health and rely upon drugs to keep them alive, we will weaken each and every generation.

    I just wandered into this website by mistake and simply had to comment. For all if you academics that feel so self important, the body does not have any drug deficiencies and yet half the country is on at least one. Drugs should be a last resort instead of first. Then again what would the medical model be without them? There’s always barber school.

    1. Harriet Hall says:

      “you can’t expect the nutrient levels in our foods to magically sustain themselves over thousands of years via farming”

      I don’t expect anything to happen magically. I do expect that a wild plant with a certain nutrient content would naturally continue to have an essentially unchanged nutrient content whether it reproduces with or without the intervention of a farmer. And studies bear that out.

    2. Windriven says:

      ” In the last interview we all realized this was a poor fit.”

      Yeah, I can see how that happened.

    3. Harriet Hall says:

      “Drugs should be a last resort instead of first.”

      Really? What would you suggest we use as a first resort for a patient with syphilis, gonorrhea, type I diabetes, bacterial pneumonia, HIV/AIDS, malaria, anaphylaxis, an asthma attack, a seizure disorder, intestinal parasites, leprosy, tuberculosis, amebiasis, angina pectoris, cardiac arrhythmias, glaucoma, pyelonephritis, thyroid storm, gout, rheumatoid arthritis, myasthenia gravis, malignant hypertension? I could go on…

      I think you did, indeed, “wander into this website by mistake.” You can either take your ill-informed opinions elsewhere or you can stay and learn about science-based medicine.

      1. Jeff says:

        Apparently I offended a few of you and am not surprised. In emergency and critical care situations I would agree a drug may be of some use. Then again my sons girlfriend is an ER doc and the stories she tells about screw ups are a little scary.

        I have to admit its a miracle the human race survived without a Wallgreens on every corner. Guess that only the strong survive thing was overrated. It would be one thing if drugs really made a difference other than looking good on a lab report. I’m 62, no meds for over 45 years because I do things to PREVENT disease. No flu shots, no statins and NEVER any antibiotics. Guess I’m just lucky? Luck has nothing to do with great health. It’s something you EARN.

        Back pain is the second most common complaint in the US and is getting worse. Back pain is a symptom and yet the Medical Model treats it like a condition. All that medical schooling so you can write a script for a pain pill. Wow. That’s impressive. We could train a monkey to do that. Maybe the big idea would be to look for the cause of the pain but that would be asking a lot. No wonder CMS came out saying spinal surgery is a waste if time a month ago. What will happen when the CDC finally gets around to saying that medication for back pain is about the dumbest idea one could imagine. Then again there is no money in wellness.

        In my area more and more MD’s are using supplements. It’s funny because they have no idea what they are doing. They tell patients to drink soy milk and eat more grains. Can they be any more stupid if they tried? And this is science based medicine?

        If I do my job, they learn what it takes to get and stay well by themselves. What a concept. The fact that they have to study why people feel better when the eat right and exercise proves my point. Because what I have been doing with my patients for the last thirty six years is what SCIENCE BASED MEDICINE is proving to be true today. Maybe someday they can catch up with me.

        I have always felt that the medical profession knows a lot about disease but really nothing about health. Does that not explain why patients never seem to get better? The absence of disease does not equal great health. I’m wondering how much further can we lower the bar? What’s health these days? Being on all the right drugs? It’s sad how much the public does not know about wellness and I remain sickened by how little the medical world has done to teach them. Is that science? Really?

        1. Windriven says:

          “Apparently I offended a few of you and am not surprised.”

          You haven’t offended me. You’re a chiropractor. Your “profession” is based on prescientific quasi-religious bunk.

          You disgust me. Nothing more.

        2. Dave says:

          Luck has a LOT to do with good health. I am 64 and quite healthy and also do everything I can to keep that way, but realize that I am also very lucky. One of my friends did “everything right” – vegetarian, rode her bike everywhere rather than drive, got lots of exercise, didn’t smoke etc – died of amyotrophic lateral sclerosis. Another friend, an alpine mountaineer, has right ventricular hypoplasia and now has an AICD in. He did nothing to get that problem. People with multiple sclerosis, Parkinsonism, hypothyroidism, infectious diseases of all sorts, etc etc do NOTHING to get their disease. Women with breast cancer and men with prostate cancer have not done anything to cause their problems. My brother died of leukemia – how is he responsible for that? Granted, you can help prevent atherosclerosis, diabetes (sometimes, not type 1) and several kinds of cancers by lifestyle changes. But if you think living right will guarantee that you will not get sick you are sadly mistaken. Pick up a standard medical textbook, go through the chapters, and see how many disease are actually preventable by lifestyle alone. Then come back and tell us how great you are because you’ve EARNED your good health and luck has nothing to do with it. Every day I see patients with terrible problems and think “there but for the grace of God go I”.

          1. Dave says:

            One more point – you state the public knows little about good health. I think everyone knows that they should not smoke, not drink to excess, eat their fruits and vegetables, get a lot of exercise, etc. I knew all that before I got out of grade school. I did not need a doctor to tell me this. I know of NO ONE who thinks being a couch potato, smoking or eating lots of sugar or fast foods is healthy. So what great insights are you telling the people you see that they don’t already know or haven’t heard before? Please back that insight up with evidence if you reply.

            You have a very limited viewpoint. If a patient comes to a physician with hypertension, diabetes, hyperlipidemia, that patient has risk factors to develop heart attacks, strokes, renal failure, and congestive heart failure down the road. Step number one is lifestyle change. If that doesn’t work or the patient won’t do it you use meds in an attempt to keep these catastrophes from occurring. The conditions I’ve mentioned are largely asymptomatic until the end-organ damage occurs. Then they’re quite ill.

            As far as back pain, back pain is common and usually self limited. Studies I’ve seen indicate that the same percentage of patients improve whether they see a chiropractor, MD, physical therapist, or read a pamphlet on back pain, though their satisfaction levels vary. Chronic back pain is a different issue. Perhaps that could be a topic for a post here.

        3. weing says:

          I’ve always said that it’s better to be lucky than good. You are proof of that. Hope you’re not offended.

        4. Chris says:

          Jeff: ” I’m 62, no meds for over 45 years because I do things to PREVENT disease. No flu shots, no statins and NEVER any antibiotics. Guess I’m just lucky? Luck has nothing to do with great health. It’s something you EARN. ”

          Oh, is that so? What did Elizabeth Hughes do to “earn” type 1 diabetes? Be specific, but first click on the link.

          What did my son do to earn the extra heart muscle that was partially blocking blood flow out of his heart? Do tell us how one is supposed to prevent obstructive hypertrophic cardiomyopathy.

          What did Roald Dahl’s oldest child, Olivia, do to “earn” her fate with measles?

          Answer these questions with some actual scientific evidence, along with Dr. Hall’s list of conditions (“syphilis, gonorrhea, type I diabetes, bacterial pneumonia, HIV/AIDS, malaria, anaphylaxis, an asthma attack, a seizure disorder, intestinal parasites, leprosy, tuberculosis, amebiasis, angina pectoris, cardiac arrhythmias, glaucoma, pyelonephritis, thyroid storm, gout, rheumatoid arthritis, myasthenia gravis, malignant hypertension”). Or just slither away with your Dunning Kruger sense of healthy entitlement.

        5. Harriet Hall says:

          “I’m 62, no meds for over 45 years because I do things to PREVENT disease.”

          I’m 68 and have never had an automobile accident because I prevent accidents by wearing earrings.

          My claim is every bit as valid as yours, and supported by just as much evidence.

        6. Andrey Pavlov says:

          I have to admit its a miracle the human race survived without a Wallgreens on every corner. Guess that only the strong survive thing was overrated.

          I love it when quacks try to invoke the history of our species in their defense. They always neglect to consider the fact that until the advent of scientific medicine our species lived in misery and squalor, with a life expectancy half of what it is today, and a population never even remotely approaching what we currently have. Looking at a graph of the world’s population over time one notes that it hovered very steadily at well under 500 million for most of our history and then a small increase to around 1 billion leading up to 1800 where it was steadily increasing very slowly until all of a sudden around 1920-1930 it exploded.

          Chiroquackters had been around for a few decades at that point, as had homeopaths. Chinese medicine had been around for thousands of years, as had myriad other “healing systems.” But it was in 1910 that the Flexner report came out and the subsequent 20 years was a firestorm of scientific advance in medicine around the world. Yes, that one graph only demonstrates a correlation. But all the rest of the data and knowledge show it is actually a causation.

        7. WilliamLawrenceUtridge says:

          Guess that only the strong survive thing was overrated.

          You don’t apparently realize that “strength” is not how science actually views evolutionary success; science speaks in terms of “fitness to environment”, which can mean anything from actual physical strength to SNPs that make you less vulnerable to influenza. Oh, and stops working past childbearing age. Humans are not bred to live long, disease-free lives, but they can if they follow conventional instructions – exercise, eat well, sleep.

          I’m 62, no meds for over 45 years because I do things to PREVENT disease. No flu shots, no statins and NEVER any antibiotics. Guess I’m just lucky?

          Yes, extremely so.

          Luck has nothing to do with great health. It’s something you EARN.

          Tell that to Steven Hawking, or Lou Gherig, or Woody Guthrie.

          Back pain is the second most common complaint in the US and is getting worse.

          Back pain is not characteristic of most other conditions – it is intractable and unexplained. Sam Homola, a chiropractor who abandoned the nonsense roots of his profession and is now basically a physiotherapist who specializes in back pain, treats it mechanically and doesn’t schedule more than six visits with a patient. I hope you follow his example.

          Then again there is no money in wellness

          Question – do you give “maintenance adjustments” to your patients? Just wondering, since there’s no money to be made in wellness, presumably theres’ some to be made in maintenance.

          If I do my job, they learn what it takes to get and stay well by themselves

          How does that work for acute trauma? Or cancer? Alzheimer’s? Bleeding ulcers? Smallpox?

          Because what I have been doing with my patients for the last thirty six years is what SCIENCE BASED MEDICINE is proving to be true today. Maybe someday they can catch up with me.

          What’s science-based about spinal manipulation? Aside from back pain, its sole indication (and the reason why physiotherapists are now offering spinal manipulations for back pain).

          It’s sad how much the public does not know about wellness and I remain sickened by how little the medical world has done to teach them.

          I’m pretty sure the public knows being an obese, sedentary smoker with type II diabetes is not the definition of wellness, but convincing them to get off their fat asses, put down the chips and cigarettes and go for a walk is a different matter. Sadly, the health effects of millions of short-term behaviours over your lifespan are not immediate, and humans are pretty terrible at seeing the long-term consequences of short-term behaviours. Doctors routinely tell patients how to stay healthy, it’s ubiquitous in popular culture, but I suppose you can lead a person to the fork, but you can’t make them put it down.

        8. Jan says:

          ever heard of the “Just World Hypothesis”, Jeff?
          http://knowledge.sagepub.com/view/socialpsychology/n306.xml

          Yes, you are “just lucky”. I hope that keeps working out for you, but I also hope you learn to be more generous in your views of others.

          Many people who get sick, even with amorphous illnesses, do actually practice prevention. Some don’t, but some who don’t take any preventative measures also never get ill.

          The problem with ill-defined conditions is with the doctors and researchers and with the funding structures who choose not to adequately fund certain things, and with limitations of current technology. It is not the patients’ faults.

    4. WilliamLawrenceUtridge says:

      Even an idiot would get that you can’t expect the nutrient levels in our foods to magically sustain themselves over thousands of years via farming.

      An idiot might notice the supplementation of crops through fertilizers. Not to mention the fact that human lifespans have been increasing even as our farming becomes more intensive.

      Their interest in me was predicated on my unique approach to restoring health WITHOUT medication. In the last interview we all realized this was a poor fit.

      Why, did they realize you offered nothing that a good physiotherapist or nutritionist doesn’t offer, but with less oversight? Or that your “unique approach” was less “unique” and more “worthless”?

      As long as the medical profession can continue to dupe the fat, stupid recalcitrant public into doing nothing to restore their own health and rely upon drugs to keep them alive, we will weaken each and every generation.

      Funny, my doctor never attempted to convince me to reduce the amount of exercise I get (daily) or the number of fruits and vegetables in my diet (on the order of several cups per day). It seems to me the medical profession is attempting to convince the fat, stupid, recalcitrant public to get off their couches and go for a walk, ideally to a grocery store to buy ingredients that can be used to cook healthy meals. Doctors can hardly be blamed for patients who do not follow their advice.

      For all if you academics that feel so self important, the body does not have any drug deficiencies and yet half the country is on at least one.

      The body is also not evolved to survive past childrearing age, which is why it starts to break down once you break 40. But call me crazy – I think that people should try to maximize their quality and quantity of life rather than adhering to the whims of the indifferent world that spawned our species. Drugs, which interfere with the body’s breakdown, are part of that effort, and I’m quite happy my parents and grandparents still live today thanks to these drugs.

      Drugs should be a last resort instead of first.

      Indeed, if type II diabetics the world over ate less and exercised, then perhaps they might not be needed quite so much. Though I’m curious what your recommendation might be for someone coming in with an acute cervical arterial dissection.

      Ah, of course, I don’t need to wonder – you are a chiropractor. So, adjustment then, to correct the subluxation.

      Then again what would the medical model be without them?

      You ever notice how the news is always talking about the shortage of doctors? If patients routinely followed medical advice of “vaccinate, exercise, eat less, eat well and sleep”, there probably woudln’t be. But doctors would get along just fine, they would specialize in different areas such as acute care and rare diseases instead. And you would have the money for it, since the health care burden would be less.

      A fact widely recognized by doctors.

  10. Xplodyncow says:

    Thanks to Big Supplement, I find it difficult to run my non-rigorous, non-randomized, open-label phase 4 clinical trials (n=1; me).

    For example, I wanted to add S-adenosyl methionine (SAM-e) to my medication regimen because SAM-e supposedly affects dopaminergic transmission. But how do I know the pills I purchase actually contain as much SAM-e as stated on the label? What’s the maximum dose? Will SAM-e interact with anything else I’m taking?

    According to my research, the answers are “good luck,” “infinity,” and “who knows?”

    At least if I had a PI to refer to, I could get more accurate answers (in theory anyway). Also: insurance would cover it.

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