Hopefully by this time I have already established in my first two posts on this subject that there are some serious problems in terms of quality in the supplement industry. To verify some of those assertions, consider the following list of just a few of the common problems that exist in dietary supplements:- Inaccurate label claims of herbal products. Monmaney T. Labels’ potency claims often inaccurate, analysis finds. Los Angeles Times, August 31, 1998.
- Lactobacillus products mislabeled and contaminated. Hughes, et al. Microbiologic characteristics of Lactobacillus products used for colonization of the vagina. Obstet Gyneocol 1990;75:244.
- Herbs seriously contaminated with heavy metals and pathogens. Bateman, J. Possible toxicity of herbal remedies. Scottish Med J 1998;4:7-15.
- Nutrient interactions inhibit mineral absorption from multiple vitamin-mineral supplements. Shils, et al. Modern Nutrition in Health and Disease Vol 1.8th ed. Philadelphia: Lea & Febiger; 1997. pp. 216-217.
- Calcium supplements contaminated with lead. Bourgoin B, et al. Lead Content in 70 Brands of Dietary Calcium Supplements. Amer J Pub.Hlth. August 1993, Vol. 83, No.8
- Herbal weight loss products cause lethal side effects because of being tainted with dangerous drugs. August 2002, Media Inquiries: 301-827-6242
- Herbs contaminated with mold. Halt M. Moulds and mycotoxins in herb tea and medicinal plants. Eur J Epidemiology 1998;14:269-74
- Liver failure and serious liver injury occur with herbs contaminated with drugs. U. S. Food and Drug Administration Center for Food Safety and Applied Nutrition Office of Nutritional Products, Labeling, and Dietary Supplements November 19, 2001
So how can you know if a supplement company is in the health science business rather than in the business of selling pills? Here are some things to look for:
1. GMP certification. Like I mentioned in my first post, this is the ONLY way to know if a company is just tooting their own horn or if the quality of the company has been analyzed by a reputable third-party placing their stamp of approval on their manufacturing systems.
2. Assays. An assay is an analysis of finished products and their individual ingredients. Most companies do not perform assays because they are not required by the FDA and they are expensive. But this is the only way to tell if a batch is contaminated with mold, fungus, heavy metals, pharmaceutical agents, or other foreign substances. Many companies that do perform assays do them randomly, perhaps one batch out of every 10 or 20. However, responsible quality control demands that assays be performed on every batch because purity is not guaranteed with every batch of new raw material.
3. Human evaluations for safety and efficacy. Unfortunately, this is a rarity in the supplement industry. Most companies base the safety and efficacy of their products upon third-party research done on various individual ingredients, but they do not test the actual products themselves in a clinical setting. It cannot be assumed that just because the third-party research on Echinacea, for example, showed a certain degree of safety and efficacy does not mean that once the Echinacea is manufactured into a product in a particular facility that it is then going to pass stringent QC/QA measures and that it will have that same effect in the clinical setting. This is especially true when the ingredient is combined with other agents. Most third-party research is done on individual ingredients, not on combinations. So most supplement manufacturers produce products simply assuming that if the research on Echinacea shows benefit in immunity, and the research on Goldenseal shows similar benefit, then why not combine them for an even better result? While that works out sometimes, at other times ingredients can actually compete with one another and cancel each other out. So it is important that there be a system in place that provides human safety and efficacy studies on the finished products to be able to provide a high level of predictability.
4. Extensive scientific Team. Most companies, if they have scientists on staff at all, have maybe 2 or 3 overseeing the entire operation. I find it difficult to believe that 2 or 3 scientists, or even a half dozen, could efficiently oversee the formulation, manufacture, and testing of thousands of bottles per month of product while also keeping abreast of the latest research. I didn’t say it couldn’t be done. I just said I find it difficult to believe that it could be done efficiently. I tend to trust a broader range of expertise which incorporates botanists, professional wild crafters of herbs, PhDs, MDs, chiropractors, clinical nutritionists, and naturopaths all working together to pioneer breakthroughs in the nutritional industry, to produce nutriceuticals that pass the scrutiny of all the various disciplines involved, to stay abreast of all the latest research, and to oversee the operations. If I needed a heart operation, I would want at least two qualified heart surgeons on hand, several nurses, an anesthesiologist, etc, rather than trusting my health to just a couple of guys with stethoscopes. Nutritional products are no different. We take them into our bodies. They affect our biochemistry, and I want mine to be produced by the most extensive scientific team with the most years of experience possible.
5. State of the Art Facilities. This goes back to GMP certification. A manufacturer can throw a few scientific-sounding terms your way to make their operations sound impressive, but you really have no idea what their operations involve without a third-party analysis of their facility and operational system. I had one doctor tell me that he toured the facility of a doctor’s line supplement company who I will leave nameless, and he said that it really wasn’t anything more than a big dank warehouse with a few machines. And yet somehow they were still proud enough of the place to give tours of it. That’s not what you want to see from a supplement company, especially one that is marketing their goods to doctors.
6. Product Innovation. One of the elements that a sophisticated product line should possess is unique product innovation and industry firsts. A true science-based company that is helping to blaze new trails in nutritional medicine will invest in the process of scientific discovery and well-designed research to bring previously undiscovered compounds and new applic
ations for already-known compounds to the market. Honestly, most nutritional companies even in the professional market are what I call “me too” companies, meaning that they piggy-back off the research and product innovation that other companies have already pioneered and create their own spin-off products with slight variations and cheaper price tags. In a free market system that is certainly a legitimate way to forge a business. However, if enough practitioners patronize me-too companies based upon getting what they hope will be the same kinds of products for less money, eventually all the companies who actually invest in research will no longer be in business, or at least not be able to do the research any longer.
As you can see, there is a lot to producing supplements that are of true quality, more than most people could ever imagine. Just looking at the ingredients on a label and checking to see if “quality” is somewhere in the marketing is not a good way to determine the quality of your supplements, and neither is looking for less expensive products necessarily. True quality costs money, and a more sophisticated line will usually reflect that in their prices. That is true of organic food, it’s true in the extent of training that certain doctors receive and the services they offer, it’s true in the automobile industry, it’s true in the clothing industry, and every industry under the sun. And it’s certainly true in the supplement industry. You get what you pay for, and when patients understand that they are more inclined to comply with the practitioner’s recommendations instead of going down to the local franchise pharmacy to purchase their supplements.
2. Assays. An assay is an analysis of finished products and their individual ingredients. Most companies do not perform assays because they are not required by the FDA and they are expensive. But this is the only way to tell if a batch is contaminated with mold, fungus, heavy metals, pharmaceutical agents, or other foreign substances. Many companies that do perform assays do them randomly, perhaps one batch out of every 10 or 20. However, responsible quality control demands that assays be performed on every batch because purity is not guaranteed with every batch of new raw material.
3. Human evaluations for safety and efficacy. Unfortunately, this is a rarity in the supplement industry. Most companies base the safety and efficacy of their products upon third-party research done on various individual ingredients, but they do not test the actual products themselves in a clinical setting. It cannot be assumed that just because the third-party research on Echinacea, for example, showed a certain degree of safety and efficacy does not mean that once the Echinacea is manufactured into a product in a particular facility that it is then going to pass stringent QC/QA measures and that it will have that same effect in the clinical setting. This is especially true when the ingredient is combined with other agents. Most third-party research is done on individual ingredients, not on combinations. So most supplement manufacturers produce products simply assuming that if the research on Echinacea shows benefit in immunity, and the research on Goldenseal shows similar benefit, then why not combine them for an even better result? While that works out sometimes, at other times ingredients can actually compete with one another and cancel each other out. So it is important that there be a system in place that provides human safety and efficacy studies on the finished products to be able to provide a high level of predictability.
4. Extensive scientific Team. Most companies, if they have scientists on staff at all, have maybe 2 or 3 overseeing the entire operation. I find it difficult to believe that 2 or 3 scientists, or even a half dozen, could efficiently oversee the formulation, manufacture, and testing of thousands of bottles per month of product while also keeping abreast of the latest research. I didn’t say it couldn’t be done. I just said I find it difficult to believe that it could be done efficiently. I tend to trust a broader range of expertise which incorporates botanists, professional wild crafters of herbs, PhDs, MDs, chiropractors, clinical nutritionists, and naturopaths all working together to pioneer breakthroughs in the nutritional industry, to produce nutriceuticals that pass the scrutiny of all the various disciplines involved, to stay abreast of all the latest research, and to oversee the operations. If I needed a heart operation, I would want at least two qualified heart surgeons on hand, several nurses, an anesthesiologist, etc, rather than trusting my health to just a couple of guys with stethoscopes. Nutritional products are no different. We take them into our bodies. They affect our biochemistry, and I want mine to be produced by the most extensive scientific team with the most years of experience possible.
5. State of the Art Facilities. This goes back to GMP certification. A manufacturer can throw a few scientific-sounding terms your way to make their operations sound impressive, but you really have no idea what their operations involve without a third-party analysis of their facility and operational system. I had one doctor tell me that he toured the facility of a doctor’s line supplement company who I will leave nameless, and he said that it really wasn’t anything more than a big dank warehouse with a few machines. And yet somehow they were still proud enough of the place to give tours of it. That’s not what you want to see from a supplement company, especially one that is marketing their goods to doctors.
6. Product Innovation. One of the elements that a sophisticated product line should possess is unique product innovation and industry firsts. A true science-based company that is helping to blaze new trails in nutritional medicine will invest in the process of scientific discovery and well-designed research to bring previously undiscovered compounds and new applic
ations for already-known compounds to the market. Honestly, most nutritional companies even in the professional market are what I call “me too” companies, meaning that they piggy-back off the research and product innovation that other companies have already pioneered and create their own spin-off products with slight variations and cheaper price tags. In a free market system that is certainly a legitimate way to forge a business. However, if enough practitioners patronize me-too companies based upon getting what they hope will be the same kinds of products for less money, eventually all the companies who actually invest in research will no longer be in business, or at least not be able to do the research any longer.As you can see, there is a lot to producing supplements that are of true quality, more than most people could ever imagine. Just looking at the ingredients on a label and checking to see if “quality” is somewhere in the marketing is not a good way to determine the quality of your supplements, and neither is looking for less expensive products necessarily. True quality costs money, and a more sophisticated line will usually reflect that in their prices. That is true of organic food, it’s true in the extent of training that certain doctors receive and the services they offer, it’s true in the automobile industry, it’s true in the clothing industry, and every industry under the sun. And it’s certainly true in the supplement industry. You get what you pay for, and when patients understand that they are more inclined to comply with the practitioner’s recommendations instead of going down to the local franchise pharmacy to purchase their supplements.
In conclusion, practitioners should help their patients understand the difference between companies that are in the health business and those that are in the business of selling pills. Those that are in the health business will adhere to the standards discussed in this and the previous posts, because as as Dr. Jeffrey Bland likes to say, “The most expensive supplement is the one that doesn’t work.”
