Are dietary supplements healthy?

Tiffany Anne Smith
ECO 1023

The Federal Food, Drug, and Cosmetic Act defines a dietary ingredient as a vitamin, mineral, herb or other botanical, amino acid, or dietary substance for use by man to supplement the diet by increasing the total dietary intake; a concentrate, metabolite, constituent, extract, or combination of the preceding substances (U.S. Food and Drug Administration, 2016).
In plain terms, supplements are an oral dose of a nutrient or compound of nutrients found in food. But the vital difference is that vitamins and minerals found in food work in perfect synchronicity with each other and isolated nutrients in the form of a supplement doesn’t give a person’s body the same health benefits of a whole food diet.

Our bodies don’t naturally need, want, or tolerate dietary supplements well. At best, it’s a wasteful use of resources, at worst it may cause us real harm. In 2008, beta-carotene supplementation was found to be significantly associated with an increased risk of lung cancer (Tanvetyanon T., 2008). In 2013, Annals of Internal Medicine systematically reviewed three trials, conducted to address the role of vitamin and mineral supplements for preventing the occurrence or progression of chronic diseases, in which they found (Guallar E, 2013):

  • No clear evidence of a beneficial effect of supplements on all-cause mortality, cardiovascular disease, or cancer
  • Use of a multivitamin supplement in a well-nourished elderly population did not prevent cognitive decline
  • No significant difference in recurrent cardiovascular events with multivitamins compared with placebo
  • The role of vitamin and mineral supplements in primary or secondary prevention of chronic disease have consistently found null results or possible harms
  • Evidence involving tens of thousands of people randomly assigned in many clinical trials shows that β-carotene, vitamin E, and possibly high doses of vitamin A supplements increase mortality and that other antioxidants, folic acid and B vitamins, and multivitamin supplements have no clear benefit
  • Nevertheless, the dietary supplement industry is a dynamic part of the U.S. economy, accounting for about $121.59 billion in total economic output, or roughly 0.68% of GDP. It’s responsible for: 754,645 jobs in the U.S. and $38.36 billion in wages, as well as $14.94 billion in Federal, state and local taxes—not including state and local sales taxes imposed on dietary supplements. (Nutraceuticals World, 2016).

 

 

 

 

With the popular promises of entrepreneurship, teamwork, flexibility and financial freedom for its salespeople, the direct selling industry earns a mention. In 2015, “wellness” was the top category at 31% of the USD 36.12 billion industry (Direct Selling Association, 2016), contributing almost 12% to the total economic output of dietary supplements in the U.S.
The industry is so massive that the global dietary supplements market is valued at USD 132.8 billion in 2016, with the U.S. accounting for 28%, and is expected to reach USD 220.3 billion in 2022 (Zion Market Research, 2017).

With seemingly unlimited profit potential and essentially no regulations to prohibit entry, competition for producers of dietary supplements is high. While all dietary supplements are similar and close substitutes and are highly differentiated in the market through advertising, branding, and marketing, no single firm has much power to influence the market price by their price; this creates a monopolistic competitive market.

As consumer purchases of supplements increase as their income increases and decrease as their income decreases, dietary supplements are normal goods. And as firms enjoy some level of market power as they differentiate themselves, dietary supplements have a slightly inelastic demand.

An inelastic demand is a result of dietary supplements miraculous ability to market their products as a reasonable precaution to prevent chronic illness. Isolated nutrients are the most popular supplements, and specialty formulas coming in second. Per the Council for Responsible Nutrition in 2014: 97% of users took vitamins & minerals such a multivitamin or vitamin D, 43% took specialty formulas such as omega-3, fiber or probiotics, 26% took herbal & botanicals such as Echinacea or ginseng, and 19% took formulas such as protein or energy drinks for sports nutrition and weight management (Council for Responsible Nutrition, 2014).

With so many options, the supplement aisle at any given local supermarket might look like a candy store – something to suit anyone’s tastes. Enterprising companies offer a supplement for sleep, activity and everything in between. Indeed, business is booming!

Users’ Views of Dietary Supplements (Robert J. Blendon, John M. Benson, Michael D. Botta, & al, Users’ Views of Dietary Supplements, 2013), a research letter published by the American Medical Association, found interesting results when users were asked why they use supplements (see Figure 2).

The reasons consumers gave for using dietary supplements is particularly interesting because of the 1579 respondents of that survey, only 30.9% said that a physician or nurse had recommended that they take a dietary supplement during the past two years. 5.5% of users said that they had been told by a physician or nurse in the past two years to cease use of a dietary supplement.

It’s no wonder that dietary supplements aren’t commonly recommended by medical professionals. The official position of the U.S. Department of Health and Human Services (National Institutes of Health, 2013), the Academy of Nutrition and Dietetics (Academy of Nutrition and Dietetics, 2016), and Harvard Medical School (Harvard Women’s Health Watch, 2013), is that a healthy, varied, whole-food diet contains all the vitamins and minerals any person needs, and that they, in their most natural form, interact with your body in thousands of beneficial ways that we don’t yet understand and dietary supplements cannot match. Some people may have deficiencies due to their life cycle, health status, or dietary restrictions, and that possibility should be explored with a physician or dietician before supplementation.

So, if consumers aren’t being advised by their trusted medical care provider to take dietary supplements, and in some cases being told to stop taking supplements, why are consumers so convinced that supplements improve their health, despite medical advice and research to the contrary?

The same way any firm convinces the public to buy any product – advertising.

Advertising is a natural feature of monopolistic competition. Firms that sell differentiated consumer goods spend typically between 10 and 20 percent of their revenue on advertising. This spending takes many forms, including ads on websites, social media, television, radio, and billboards and in newspapers, magazines, and direct mail. (Mankiw, 2016)

In America, marketing of dietary supplements is regulated by the Federal Trade Commission (FTC). The FTC has long kept its eye on marketing and advertising to consumers by enforcing truth-in-advertising laws, and dietary supplements are no exception. Under the laws, advertising claims, explicit or implied, must be true and evidence-based and violations are subject to investigation and prosecution by the FTC. The FTC publishes an advertising guide for the dietary supplement industry that outlines truth-in-advertising as it pertains to their activities (Federal Trade Commission, 2001) and also seeks to educate the public of the dangers of deceptive advertising and our responsibility as consumers, as shown in Figure 3.

As you may imagine, policing the claims made for dietary supplements is complicated and burdensome. The Former Commissioner of the FTC, Sheila F. Anthony, painted a dim picture of the current state of responsibility in her remarks at The Food and Drug Law Institute 45th Annual Education Conference in 2002 (Anthony, 2002): “Our consumer protection mandate can be daunting in the face of the endless variety and volume of deceptive claims about the safety and efficacy of dietary supplements. Chasing purported cancer and AIDS cures on the Internet, alone, could consume all of our resources. We obviously must make some difficult choices in selecting cases to prosecute. Many of our efforts have been directed at the most obvious frauds, for the most deadly diseases, and on products that present serious safety concerns. We must continue to bring these cases, but I worry that as a result there are many unsubstantiated product claims that are going unchallenged. However, I caution those that assume that they are immune to an enforcement action as long as they don’t sell dangerous products or cancer cures. We are watching all advertising media – not just the Internet, but direct mail, infomercials, coupon inserts, talk radio and national newspapers, and we are seeing questionable claims everywhere we turn.”

 

They are busy. In January 2014, The New York Times reported ”Operation Failed Resolution,” a recent initiative that follows a series of enforcement efforts in recent years against unfounded weight-loss schemes. “Operation Big Fat Lie” that charged six companies with false marketing in 2004. And “Operation Waistline” targeted seven companies that marketed the weight-loss properties of products in 2007 (Wyatt, 2014).

The advertising of dietary supplements gets so much attention because of the lack of regulating what products hit consumers shelves is so lacking it’s almost nonexistent, creating a free-for-all who wish to participate, thanks to the Dietary Supplement Health and Education Act of 1994.

Are dietary supplements healthy?

DSHEA effectively removes the burden of safety and evidence from the producers and places it on the shoulders of the Federal Drug Administration (FDA), who can flag products only after been tested in the market. In criticism, Steven Novella of Yale University School of Medicine said: “The deal that DSHEA and NCCAM made with the public was this: Let the supplement industry have free reign [sic] to market untested products with unsupported claims, and then we’ll fund reliable studies to arm the public with scientific information so they can make good decisions for themselves. This “experiment” (really just a gift to the supplement industry) has been a dismal failure. The result has been an explosion of the supplement industry flooding the marketplace with useless products and false claims.” (Novella, 2013)

Who are buying diet supplements? 49% of adults, as reported in Why US Adults Use Dietary Supplements (Regan L. Bailey, Jaime J. Gahche, Paige E. Miller, & al, Why US Adults Use Dietary Supplements, 2013). And many characteristics of people who choose supplements are known: users tend to be older, have a lower body mass index (BMI), are more physically active, less likely to smoke, and have higher educational attainment and socioeconomic status compared with nonusers.

Other observations include:

  • • Using a dietary supplement was more common in women than men
    • Older adults (≥ 60 years) and non-Hispanic whites reported higher use than the younger age groups and other races
    • Individuals classified as underweight or obese were less likely to use supplements than normal and overweight individuals
    • Those with health insurance were much more likely to report supplement use than those without insurance
    • Supplement use was also lower in those with low reported exercise, higher in those who reported one alcoholic drink per day, and higher among those who reported excellent or very good health

As it turns out, users of dietary supplements exercise, eat well, make more money, and have good access to healthcare than non-users. Basically… Me.

With an unbalanced elderly population, uncertain healthcare access, and powerful advertising pushing unrealistic images of perfect health and the perfect body, there are many reasons Americans are turning to dietary supplements to get the nutritional benefits they need. Given that people may be unsure or uneducated about what constitutes a healthy, balanced diet, supplements often seem like a good option to fill any nutritional gaps when in fact deficiencies may not exist.

A solution to this problem is to educate users of dietary supplements about the dangers and waste of their consumption and to educate the general public about the complete benefits of a varied, whole-food diet.

References

Academy of Nutrition and Dietetics. (2016, January 07). Vitamins, Minerals and Supplements: Do You Need to Take Them? Retrieved from EatRight.org: http://www.eatright.org/resource/food/vitamins-and-supplements/dietary-supplements/vitamins-minerals-and-supplements

Anthony, S. F. (2002, April 16). Combating Deception in Dietary Supplement Advertising. Retrieved from Federal Trade Commission: https://www.ftc.gov/public-statements/2002/04/combating-deception-dietary-supplement-advertising

Council for Responsible Nutrition. (2014). The CRN Consumer Survey on Dietary Supplements. Retrieved from crnusa.org: http://www.crnusa.org/CRNconsumersurvey/2014/

Crislip, M. (2009, September 25). Boost Your Immune System? Retrieved from Science-Based Medicine: https://sciencebasedmedicine.org/boost-your-immune-system/

Direct Selling Association. (2016). Industry Fact Sheets. Retrieved from dsa.org: http://www.dsa.org/docs/default-source/research/dsa_2015factsheetfinal.pdf?sfvrsn=8

Federal Trade Commission. (2001, April). Dietary Supplements: An Advertising Guide for Industry. Retrieved from Federal Trade Commission: https://www.ftc.gov/tips-advice/business-center/guidance/dietary-supplements-advertising-guide-industry

Guallar E, S. S. (2013). Enough Is Enough: Stop Wasting Money on Vitamin and Mineral Supplements. Ann Intern Medicine, 850-851.

Harvard Women’s Health Watch. (2013, January). Dietary supplements: Do they help or hurt? Retrieved from Harvard Health Publications: http://www.health.harvard.edu/staying-healthy/dietary-supplements-do-they-help-or-hurt

Harvard Women’s Health Watch. (2013, January). Dietary supplements: Do they help or hurt? Retrieved from Harvard Health Publications: http://www.health.harvard.edu/staying-healthy/dietary-supplements-do-they-help-or-hurt

Mankiw, N. G. (2016). Principals of Economics, 8e. Boston, MA: Cengage Learning.

National Institutes of Health. (2013, August). Should You Take Dietary Supplements? Retrieved from NIH News in Health: https://newsinhealth.nih.gov/issue/aug2013/feature1

Novella, S. (2013, March/April). Herbs Are Drugs. Retrieved from The Committee for Skeptical Inquiry: http://www.csicop.org/si/show/herbs_are_drugs

Nutraceuticals World. (2016, 06 10). Supplement Industry Contributes $122 Billion To U.S. Economy. Retrieved from nutraceuticalsworld.com: http://www.nutraceuticalsworld.com/contents/view_online-exclusives/2016-06-10/supplement-industry-contributes-122-billion-to-us-economy/

Regan L. Bailey, P. R., Jaime J. Gahche, M., Paige E. Miller, P. R., & al, e. (2013, March 11). Why US Adults Use Dietary Supplements. Retrieved from JAMA Internal Medicine: http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1568520

Robert J. Blendon, S., John M. Benson, M., Michael D. Botta, A., & al, e. (2013, January 14). Users’ Views of Dietary Supplements. Retrieved from JAMA Internal Medicine: http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1392491

Robert J. Blendon, S., John M. Benson, M., Michael D. Botta, A., & al, e. (2013). Users’ Views of Dietary Supplements. JAMA Intern Medicine, 74-76.
Tanvetyanon T., B. G. (2008). Beta-carotene in multivitamins and the possible risk of lung cancer among smokers versus former smokers: a meta-analysis and evaluation of national brands. Cancer, 150-157.

U.S. Food and Drug Administration. (2016, 07 26). Dietary Supplement Products & Ingredients. Retrieved from fda.gov: https://www.fda.gov/Food/DietarySupplements/ProductsIngredients/default.htm

Wyatt, E. (2014, January 7). Weight-Loss Companies Charged With Fraud. Retrieved from New York Times: https://www.nytimes.com/2014/01/08/business/us-charges-4-companies-with-deception-in-weight-loss-products.html?_r=0

Zion Market Research. (2017, January 11). Global Dietary Supplements Market will reach USD 220.3 Billion in 2022: Zion Market Research. Retrieved from globenewswire.com: https://globenewswire.com/news-release/2017/01/11/905073/0/en/Global-Dietary-Supplements-Market-will-reach-USD-220-3-Billion-in-2022-Zion-Market-Research.html

 

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