Dietary Supplements on the Hot Seat – Again
Jeffrey Bland, Ph.D.
Over the past forty-plus years, I have been involved in the dietary supplement area of research and development; there have been periodic attacks on the industry and the concept of dietary supplementation by factions within the medical and government regulatory communities.
The issue has again been raised with several recent editorials in the Journal of the American Medicine Association and the New England Journal of Medicine expressing concerns about dietary supplements. It is important to note that each of these editorials coincides with the publication in the same issue of a clinical research study journal demonstrating no positive impact of dietary supplements on the prevention of a specific disease.
The editorial in JAMA was entitled “Multivitamins and Supplements- Benign Prevention or Potentially Harmful Distraction?” (JAMA, June 21, 2022, pp 2294-94) in the same issue that the article “Vitamin, Mineral, and Multivitamin Supplementation to Prevent Cardiovascular Disease and Cancer” (JAMA, June 21, 2022, pp 2326-33) which showed no positive impact on the reduction of either heart disease or cancer with multivitamin-mineral supplementation was published.
The editorial in the NEJM was entitled “Institutionalizing Misinformation-The Dietary Supplement Listing Act of 2022” (NEJM, July 7, 2022, pp3-5) in the same issue that the article “Supplemental Vitamin D and Incident Fractures in Midlife and Older Adults” (NEJM, July 7, 2022, pp 299-309) which showed no positive impact of vitamin D supplementation on facture risk was published.
From these articles and their companion editorials the consumer press has once again raised the question as to whether there is any value in dietary supplements. This theme of concern about the value of dietary supplements is further reinforced with the publication in the JAMA Network August 10, 2022 of the article “Analysis of Select Dietary Supplement Products Marketed to Support or Boost the Immune System” which reported that most of the dietary supplement products tested in this study had inaccurate labels and claims. This perspective was further reinforced by the article “Recalls, Availability, and Concerns of Dietary Supplements Following FDA Warning Letters” (JAMA, July 26, 2022, pp 393-95), and “New Education Initiative on Dietary Supplements” (JAMA, July 19, 2022, p 235) that describes a collaboration
with the American Medical Association on how a health care professional can evaluate the claims and quality of a dietary supplement product. In this editorial Douglas Stearn, JD, Deputy Director for regulatory affairs for the FDA’s Center for Food Safety and Applied Nutrition was quoted as saying, “dietary supplements can be valuable to your health, but taking some supplements can also involve health risks”.
These studies and editorials have all contributed to once again questioning the value of dietary supplements. It is my opinion that this discussion has been focused on the wrong issue and has been based upon research information that is inappropriate to address the reason that many people take a daily dietary supplement.
People take dietary supplements to protect their own health. It is very personal. They do not take dietary supplements for public health benefits. The impact of a dietary supplement on health outcomes is very personal. This is analogous to purchasing life insurance. If a study was done on the individual health benefit of a person purchasing life insurance it would prove to have no statistically significant value when viewed from the public health perspective.
This is because most people will not get value out of their term life insurance premiums because due to their fortune, they will not realize its benefits. But if the individual is sick or dies, then their insurance policy has significant value to them. It may not influence the value to the population at large but is valuable to the beneficiaries.
The types of research that are done on dietary supplements are community or public health- based research protocols. They are not personalized to look for the few within the population of the study that benefitted. The statistics for these studies are therefore likely to not demonstrate a statistically significant benefit for the average person in the study, but it does not allow for an understanding of those within the study that had a positive benefit. Their positive benefits are lost in the statistics of those who it had no positive effect. This is the life insurance conundrum that can only be resolved through studies designed to look at the personal impact of dietary supplements on health outcomes.
It is, however, true that there is exploitation in the dietary supplement area by some companies that have exaggerated or unsupported claims, whose composition of the product does not accurately reflect what is in the product, and is not transparent in its ingredient selection process. Fortunately, the leading companies in the health professional channel (HPC) for dietary supplements have been standard bearers for quality. The HPC group of leadership companies working in collaboration with functional and integrative medicine-focused clinical laboratories that provide tools to assess functional health status allow for personalizing dietary supplement intervention.
It is my belief that the personalized lifestyle and nutrition therapy focus is the future. It takes the field away from the public health-community health model to a different way of personalizing both the research and clinical application of dietary supplement-focused therapy. It is the model that will allow the field of dietary supplements to move away from the negative outcomes found with population-based studies to designs that are focused on understanding positive personal responses to dietary supplement intervention for those in need.
This is the approach to dietary supplementation that Dr. Linus Pauling described in his concept of Orthomolecular Medicine in 1968. We now realize the potential of personalization due to the advance in technology in defining biochemical individuality with much greater precision through the evolution of cooperation between the Functional and Integrative clinical laboratories and the dietary supplement companies providing nutraceutical-quality products. I have attached a recent article I authored that describes the evolution and application of this concept for your review.
Sincerely,
Jeff
Jeffrey Bland, Ph.D., FACN, FACB
President
Personalized Lifestyle Medicine Institute
