Got Any Snake Oil?Shoppers searching for dietary supplements in health food stores may get useless, even deadly, advice. The industry says it is improving and policing itself.
Reviewed by Dominique S. Walton, MD, MBA
Dec. 11, 2000 -- The herb ephedra can cause some serious side effects, from high blood pressure to strokes and seizures. But the clerk at the health food store didn't mention any of that when I asked her for a product that would help me lose 10 pounds.
Instead, she suggested some products that might do the trick: meal replacement shakes, pyruvate (a substance said to increase metabolism) and L-carnitine (a so-called fat burner).
On I went to four other health food stores, asking the same question. The list of recommendations got longer, with clerks suggesting other types of "fat burners," chitosan (promoted as a fat absorber), ciwuja (a relative of ginseng promoted as a fat metabolism booster), and green tea extract.
Each clerk sounded convinced that the product he or she was recommending was the best for weight loss. Never mind that I didn't see a single piece of literature confirming that the products worked (even though I often asked). And although some of the suggested products contained ephedra (sometimes called ma huang), no one mentioned what I already knew: that two San Francisco researchers recently found an alarming number of ill effects, including high blood pressure and stroke, associated with that supplement.
In wake of Congress deregulating the health food industry with the Dietary Supplement Health and Education Act of 1994 (DSHEA), the business of handing out unproven remedies has mushroomed to a $15 billion industry. Doctors and herbalists alike are becoming concerned that many people are spending their money for substances that will not help and may even hurt them.
So when it comes to getting advice at the health food store, the quality of the advice being dispensed is anyone's guess, and the environment is definitely caveat emptor, or "let the buyer beware." That point was brought home not only by my personal experiences, but also by at least three recent medical journal reports:
The San Francisco doctors reviewed 140 reports of ill effects related to the use of dietary supplements containing ephedra and concluded that almost two-thirds either were definitely, probably, or possibly associated with use of the supplement. High blood pressure was the single most frequent adverse effect, followed by heart palpitations, rapid heart rate, stroke, and seizures. Due to potential public health implications, the findings were released early by The New England Journal of Medicine, which plans to publish the final version of the report Dec. 21.
A University of Hawaii researcher who posed as the daughter of a breast cancer patient and visited 40 health food stores in Hawaii asking for advice was frequently told her mother should take shark cartilage, an unproven remedy that has been associated with liver toxicity, nausea, fever, and other ill effects in cancer patients. Her study appears in the August 2000 issue of the Archives of Family Medicine.
Doctors from Belgium and Germany discovered that the Chinese herb Aristolochia fangchi may cause not only kidney failure but urinary tract cancer, according to a report published June 8 in The New England Journal of Medicine. The researchers followed 105 patients treated with the herb at a Belgium weight loss clinic. End-stage renal (or kidney) failure developed in 43. And nearly half of the 39 who agreed to preventive removal of the kidneys were found to have urinary tract cancer. The FDA issued an import alert on the herb to ban its entry into the country.
This information doesn't seem to have filtered down to those who sell supplements. When I recently called the same five health food stores I had visited, asking if they carried aristolochia, four said no and one clerk asked me to call back when her boss returned. No one mentioned the import ban, and one suggested he might be able to order the herb for me.
So what should health food store clerks tell you and what can you do to protect yourself while supplement-shopping? How can consumers decide if they are being given potentially dangerous medical advice?
The fine line
The fine line between selling and giving medical advice is of concern to the health food industry, too, insiders say. Those who sell supplements should know their product, says Gayle Engels, a spokeswoman for the American Botanical Council, an education and research organization in Austin, Texas. But they should not dispense any medical advice. "All the information we put out says, 'This information is not intended to replace the information provided by a health care professional.'"
To be on the safe side, "retailers should not go much beyond label statements," says Diane McEnroe, an attorney for Sidley & Austin, the general counsel for the National Nutritional Foods Association, an industry group based in Newport Beach, Calif., representing health food stores and manufacturers and suppliers. The best response to someone like me who asks for help in losing weight, McEnroe says, is to tell the customer there are a variety of products that help with weight loss and that they work different ways: some affect metabolism, others help with the absorption of fat, for instance.
A clerk would cross the line, McEnroe adds, if he or she talked about obesity, a disease, or miracle solutions designed to be taken at night so you lose weight as you sleep. Under DSHEA, claims about how a dietary supplement may help prevent or treat a particular disease condition are not permitted. A consumer interested in weight loss supplements should also expect to hear about the importance of a good diet and exercise program, McEnroe says.
Health food stores can also distribute promotional literature from the manufacturer if the claims are limited to what's known as structure and function claims (this supplement helps preserve joint maintenance) and not disease claims (it can't cure arthritis). Consumers should also expect to see more "third party literature" -- reports about supplements authored by independent experts that don't mention supplements by brand name, which are also permitted under DSHEA.
There's no standardized training for health food store employees, but large chains insist they invest heavily in employee training. "We have invested millions of dollars in a state-of-the-art interactive training programs to ensure that employees are educated on GNC brand products and their benefits," says Roberta Gaffga, a company spokeswoman.
More on my shopping trip
When I visited the five health food stores -- four chains, one mom-and-pop -- no one promised me miracle weight loss and no one talked about obesity. One clerk, at a GNC near Los Angeles, quizzed me before suggesting anything. She asked how old I was, whether I had high blood pressure or heart disease, whether I worked out, and how nutritious my diet is.
Her questioning, however, was the exception. No other clerk asked a thing about my health habits or medical history.
Consumer, educate yourself
In the current deregulated climate, consumers should educate themselves before even setting foot in a health food store, suggests Varro Tyler, PhD, professor emeritus of pharmacognosy at Purdue University, West Lafayette, Ind., and an herbal expert. Most health food employees, he says, are business people. "And many [stores} hire young people, high school students, as clerks, and probably they repeat what they heard the boss tell them" about products.
And what does Tyler think of the recommendations I got? Meal replacements will help if you don't also eat a meal, he says, but pyruvate, L-carnitine, chitosan, and ciwuja are all unproven for weight loss. Green tea extract, if it includes caffeine, will help burn more calories, he says, but the weight loss effect is negligible. Ephedra with caffeine formulas work best for weight loss, he adds, but many people's health histories make those products risky to take.
Tyler proposes that the industry set up some sort of standardized educational program. But, he adds, "I don't think it will ever happen."
Meanwhile, consumers should read up on supplements before going to the store, Tyler says. Among the bibles in the field: Tyler's Honest Herbal, by Tyler and Steven Foster, now in its fourth edition; and Herbal Medicine: Expanded Commission E Monographs, edited by Mark Blumenthal, founder of the American Botanical Council.
"Get information from someone who is not selling the product," Tyler urges. "Trust authors who do not have an herb company."
It can't hurt, as well, to keep an ear out for medical journal reports publicized in the press, such as the recent ephedra supplement study.
Kathleen Doheny is a Los Angeles-based health journalist whose work has also appeared in the Los Angeles Times, Shape, Fit Pregnancy, Modern Maturity, CNN.com/HEALTH, and other publications.