Supplements in the crosshairs, again

Supplements in the crosshairs, again

A new book from Dr. Paul Offit charges alternative medicines and dietary supplements with not only a lack of efficacy, but the potential for real harm in certain populations. Early press surrounding the book's release points fingers squarely at supplements, in particular common antioxidants like beta carotene, selenium, and vitamins A, C and E.

Dr. Paul Offit is chief of the infectious diseases division at the Children's Hospital of Philadelphia. Offit is also the co-inventor of RotaTeq, a vaccine prescribed universally in infants for the prevention of rotavirus.

In advance of Offit's latest book, Do You Believe in Magic?, op-eds and excerpts have recently appeared in The Guardian and the New York Times, raising arched eyebrows from within the supplement industry. Offit questions the value of traditional supplementation and our blanket fear of free radicals (an instigating factor in market growth for antioxidants), but then goes on to posit increased morbidity risks from over-supplementation, citing many of the studies the supplement industry already knows and loves to hate.

After publishing an interview with Offit, NBJ asked for comment from several thought leaders in and around the supplement industry. Their responses appear after the jump.

CRN: 'Nothing we haven't heard before'

We’ve read the book, and there’s really nothing we haven’t heard before. Cherry picking the science, misinterpreting the regulation, and using extreme examples to disparage both supplements and supplement users. Even the concept ‘alternative medicine’ is old and tired. Consumers want options for incorporating supplements into their healthy lifestyle choices; they understand that taking supplements doesn’t replace other healthy habits like good diet, exercising or seeing your doctor regularly. In fact, research demonstrates that supplement users are more likely than non-supplement users to do those kinds of things. They’re looking at supplements as smart prevention, and consider them integrative, not alternative, health decisions. We expect more bad publicity, but aren’t getting riled up about it. We always encourage consumers to talk about their supplement use with their healthcare practitioners, and we hope that the book’s dismissive nature of the value of supplements doesn’t discourage supplement users from talking to their doctors about their supplements.

— Judy Blatman, Senior VP of Communications, Council for Responsible Nutrition

Nestle: 'Supplements aren't about evidence-based medicine'

I don’t know why anyone would be surprised by Paul Offit’s op-ed. Nutrient supplements are great for people who have nutrient deficiencies. Whether they make people worse, as Offit suggests, is arguable, but study after study shows that nutrient supplements do not make healthy people healthier. Science, however, has never been a driving force for supplement taking. To arguments that supplements do no good, the 50% of American adults who take these things would say, 'So what. I’m taking them anyway.' Supplements aren’t about evidence-based medicine. They are about deep distrust of modern diets, science, and the health care system. People feel better when they take supplements, sometimes much better. They are powerful placebos, if nothing else, and I’m not convinced they are seriously harmful. Do I recommend them? Not a chance. But I’m not upset when I hear that people take them. My advice: supplements, like everything else about nutrition, should be taken in moderation.

— Marion Nestle, Professor of Nutrition, Food Studies and Public Health, New York University, and author of What to Eat

Sapsin: 'Meet him on his own ground'

Paul Offit's recent opinion pieces pose one of the great questions which must be confronted by the natural/consumer health industry: How do we respond to critics operating within the medical/scientific 'establishment,' with whom we may disagree? Some will respond to Offit's views by claiming his science is biased; some by alleging he selectively cites his sources; others, that the scientific approach he takes is flawed ab initio.  

To progress as an industry, however, we must take Offitt's expression of opinion as a challenge and call to action. First, we must be willing to assume that he is acting in good faith, that he believes his presentation of evidence to be, on the whole, accurate. Second, we must accept that he is acting within a 500-year-old tradition of rational, 'scientific' inquiry which has brought tremendous medical and technological advances.

To capture the largest body of public opinion and do the most good, we should meet him on his own ground. We must confront the studies he cites: e.g., do they withstand traditional, rigorous, scientific scrutiny? And if so, do they then require that we consider modifying our approach?  

Offitt's opinion emphasizes the importance of moving to the next level of engagement with the public on the foundational issues of nutrition and the science of health. As with the debate over climate change, the fervency of our 'beliefs' about supplements (like 'beliefs' that climate change is a hoax) must not become the measure of our industry's commitment to health and wellness.  

Unless we are a religion, what matters in the final analysis is that which we can prove using the best intellectual and technical tools available. As the renaissance and enlightenment thinkers realized centuries ago, everything else is simply either theory or, worse, superstition.

Jason Sapsin, JD, MPH, Of Counsel at Polsinelli PC

Bland: 'The system Offit tries to protect is not working to reduce the burden of chronic disease'

Dr. Paul Offit’s new book offers yet another iteration of the same criticisms of nutritional supplements that we have seen since the Senator Proxmire days in the 1970s when the FDA wanted supplements categorized as drugs. My takeaway from this book for the nutrition industry is that it must continue to seek the protection of solid science and the clinical support of structure function or medical food claims. This is another opportunity for the industry to voice its message from a position of strong science, and as part of an overall plan to deliver personalized lifestyle healthcare to the public. The present system Offit tries to protect is not working to reduce the burden of chronic disease. This is the time for a different model to be taken seriously.

With that said, I do take issue with Offit on a few specific points worth further discussion:

  1. Nutritional supplements do not need 'black box warnings,' and are nothing like Vioxx with its safety issues. I do not believe Offit does a responsible job of evaluating the adverse events record associated with legal nutritional supplements versus the adverse event record for pharmaceuticals.
  2. Offit fails to represent the emerging science of nutrigenomics and the increasing, scientifically proven, clinical value of specific nutritional supplements for the management of certain health conditions. There are literally thousands of studies on the benefit of omega 3 fatty acids, not to mention the body of research around nutrients—such as magnesium, calcium, iron, folate, and vitamin B12—whose importance in doses exceeding the present RDI values is well established.
  3. Offit also fails to discuss the revolutionary discoveries over the past ten years of the role that specific phytonutrients have on physiology, and the clinical studies now available indicating their positive health benefit.
  4. The argument that 'everything is toxic at some level,' while true, is of little value to consumers in evaluating the range of safe intake for nutrients versus that of drugs. This is misleading, in my opinion, and not in the interest of the public good. Advancing this argument offers little redeeming contribution to raising the bar on an intelligent and thoughtful evaluation of the pros and cons of nutritional supplements, or any other of the 'alternative' therapies Offit scrutinizes in his book.

—Jeff Bland, PhD, Founder & President, Personalized Lifestyle Medicine Institute

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