30 years since the Dietary Supplement and Health Education Act (DSHEA)
April 16, 2024 12:39 PM Subscribe
What's in your prenatal vitamin? Dr. Gunter on the recent U.S. Government Accountability Office's report: Only one product contained everything listed on the label (within the accepted deviation).
What's really in that sports supplement? 23 of the 57 products (40%) did not contain any detectable amount of the labeled ingredient. 7 of the 57 products were found to contain at least one FDA-prohibited ingredient.
Revealing the hidden dangers of dietary supplements (and archive version): Since 2005, when he found his patients were being sickened by a Brazilian weight loss supplement containing anti-depressants and thyroid hormones, Cohen has become something of a mix of Indiana Jones and Sherlock Holmes in the supplement world.
Extra: The DSHEA and supplements made Alex Jones.
What's really in that sports supplement? 23 of the 57 products (40%) did not contain any detectable amount of the labeled ingredient. 7 of the 57 products were found to contain at least one FDA-prohibited ingredient.
Revealing the hidden dangers of dietary supplements (and archive version): Since 2005, when he found his patients were being sickened by a Brazilian weight loss supplement containing anti-depressants and thyroid hormones, Cohen has become something of a mix of Indiana Jones and Sherlock Holmes in the supplement world.
Extra: The DSHEA and supplements made Alex Jones.
The only sports anything I drink is Gatorade, because it actually contains salt and potassium at significant enough levels to promote hydration.
posted by grumpybear69 at 1:35 PM on April 16 [2 favorites]
posted by grumpybear69 at 1:35 PM on April 16 [2 favorites]
This is so depressing. The whole supplement industry, aside from the other messages it puts forward more explicitly, also has an underlying message that you can be in charge of your health, that you can experiment and find something that makes you feel better, without going through endless medical gatekeeping. But, y'know, if you're finding 1,4-dimethylamylamine in your capsule, you've been lied to in a really dangerous way. It's almost better if they're just selling you a placebo, at least then you're not going to drop dead. (Dear Costco: Please tell me this multivitamin I got the other day is just a placebo, I'm not ready to drop dead.)
There has to be some middle ground between "you will only take pills prescribed by your doctor and advertised on TV" and "we sneaked some drain cleaner into one of these creatine canisters but we won't tell you which one."
posted by mittens at 1:44 PM on April 16 [14 favorites]
There has to be some middle ground between "you will only take pills prescribed by your doctor and advertised on TV" and "we sneaked some drain cleaner into one of these creatine canisters but we won't tell you which one."
posted by mittens at 1:44 PM on April 16 [14 favorites]
Major League Baseball players (and affiliated minor leaguers) have been counselled to only take supplements recommended by a doctor and/or verified by the league, because there is no forgiveness afforded players who unknowingly ingest a banned substance and fail a test and the number of supplements that contain steroids or steroid-adjacent chemicals is shockingly high.
It's sort of a running joke that as soon as a player gets popped for a failed drug test, the next words out of his mouth will be that he "unknowingly ingested the banned substance via a supplement." Seeing these stats, maybe we shouldn't laugh quite so hard at that idea. Although, again, the league does tell them not to trust anything on a label without verifying.
posted by DirtyOldTown at 1:52 PM on April 16 [2 favorites]
It's sort of a running joke that as soon as a player gets popped for a failed drug test, the next words out of his mouth will be that he "unknowingly ingested the banned substance via a supplement." Seeing these stats, maybe we shouldn't laugh quite so hard at that idea. Although, again, the league does tell them not to trust anything on a label without verifying.
posted by DirtyOldTown at 1:52 PM on April 16 [2 favorites]
There has to be some middle ground between "you will only take pills prescribed by your doctor and advertised on TV" and "we sneaked some drain cleaner into one of these creatine canisters but we won't tell you which one."
I mean, isn't that what USP is for? I know that's what I look for, but at this point if someone had evidence that was a scam as well I wouldn't be too surprised. Maybe about half of the supplements at Costco are certified by USP.
I have two other thoughts - it really makes everything so much more complicated that the average consumer of herbal pills, supplements, etc, often see them as safe, and, while they may not do what they claim to do, they will do no harm. But none of those assumptions are correct. One of the chemicals found in red yeast rice is the same as lovastatin. Well, how much are you taking of that chemical when you take a red yeast rice supplement? What about people who are concerned about their cholesterol and are on a prescribed statin, but want to do something "natural" on the side to help? Now their healthcare team has no idea how much of that chemical they're taking in on the regular. Is the new kidney damage from the statin, red yeast rice, both, or neither?
The folate labeling on pre-natals is also frustrating. I've been taking pre-natals since my 20s, and in my 30s I found out I have mutation in one of my folate processing genes that makes me less efficient at folic acid metabolism. Aha, I thought, I really need to be cognizant of this when I get pregnant. I mentioned to my OBGYN my worry about this, and she reassured me that most supplements have an over-abundance of folic acid, and it shouldn't be an issue. She never mentioned that only folic acid as folic acid is the supplement I need to look for. I checked the ACOG website just now for recommendations, and it also doesn't make this distinction. Is this an issue that we need to start making a big push for awareness?
posted by lizjohn at 2:13 PM on April 16 [4 favorites]
I mean, isn't that what USP is for? I know that's what I look for, but at this point if someone had evidence that was a scam as well I wouldn't be too surprised. Maybe about half of the supplements at Costco are certified by USP.
I have two other thoughts - it really makes everything so much more complicated that the average consumer of herbal pills, supplements, etc, often see them as safe, and, while they may not do what they claim to do, they will do no harm. But none of those assumptions are correct. One of the chemicals found in red yeast rice is the same as lovastatin. Well, how much are you taking of that chemical when you take a red yeast rice supplement? What about people who are concerned about their cholesterol and are on a prescribed statin, but want to do something "natural" on the side to help? Now their healthcare team has no idea how much of that chemical they're taking in on the regular. Is the new kidney damage from the statin, red yeast rice, both, or neither?
The folate labeling on pre-natals is also frustrating. I've been taking pre-natals since my 20s, and in my 30s I found out I have mutation in one of my folate processing genes that makes me less efficient at folic acid metabolism. Aha, I thought, I really need to be cognizant of this when I get pregnant. I mentioned to my OBGYN my worry about this, and she reassured me that most supplements have an over-abundance of folic acid, and it shouldn't be an issue. She never mentioned that only folic acid as folic acid is the supplement I need to look for. I checked the ACOG website just now for recommendations, and it also doesn't make this distinction. Is this an issue that we need to start making a big push for awareness?
posted by lizjohn at 2:13 PM on April 16 [4 favorites]
One of the key ways Alex Jones made his money was via snake-oil supplements. It was also one of the foundations of the DeVos fortune.
As a consequence it is very unlikely the legislative landscape will change. Selling you poison and placebos (yay, you'll never know which one you're getting!) is way too profitable.
posted by aramaic at 2:14 PM on April 16 [3 favorites]
As a consequence it is very unlikely the legislative landscape will change. Selling you poison and placebos (yay, you'll never know which one you're getting!) is way too profitable.
posted by aramaic at 2:14 PM on April 16 [3 favorites]
This is yet another one of the many evils perpetuated by and surviving Orrin Hatch.
posted by NoxAeternum at 2:21 PM on April 16 [16 favorites]
posted by NoxAeternum at 2:21 PM on April 16 [16 favorites]
I've been using a paid subscription at ConsumerLab.com when picking any supplements. It's the closest thing I have found so far to independent testing of such products.
posted by Hairy Lobster at 2:27 PM on April 16 [2 favorites]
posted by Hairy Lobster at 2:27 PM on April 16 [2 favorites]
This is yet another one of the many evils perpetuated by and surviving Orrin Hatch.
This.
And I’m somewhat shocked his foul name isn’t mentioned once.
posted by Thorzdad at 2:46 PM on April 16 [1 favorite]
This.
And I’m somewhat shocked his foul name isn’t mentioned once.
posted by Thorzdad at 2:46 PM on April 16 [1 favorite]
This is yet another one of the many evils perpetuated by and surviving Orrin Hatch.
It was a huge victory for the Utah supplement industry. The rest of us, not so much.
For more on this and how Orrin Hatch helped ruin nice things, season two of The Dream podcast has you covered. (Previously.)
posted by fifteen schnitzengruben is my limit at 3:27 PM on April 16 [5 favorites]
It was a huge victory for the Utah supplement industry. The rest of us, not so much.
For more on this and how Orrin Hatch helped ruin nice things, season two of The Dream podcast has you covered. (Previously.)
posted by fifteen schnitzengruben is my limit at 3:27 PM on April 16 [5 favorites]
As per Consumerlabs, some brands are consistently quite trustworthy in terms of what they claim on the label in fact being what you get in the bottle.
Unfortunately those are also the brands most likely to be counterfeited on Amazon and Ebay, thanks to ZERO CONSEQUENCES (civil or criminal) for supplement bootlegging.
You can thank DC's K Street for that.
posted by Fupped Duck at 3:47 PM on April 16 [4 favorites]
Unfortunately those are also the brands most likely to be counterfeited on Amazon and Ebay, thanks to ZERO CONSEQUENCES (civil or criminal) for supplement bootlegging.
You can thank DC's K Street for that.
posted by Fupped Duck at 3:47 PM on April 16 [4 favorites]
I mean, isn't that what USP is for? I know that's what I look for, but at this point if someone had evidence that was a scam as well I wouldn't be too surprised.
Per the first linked article by Jen Gunter, a GAO scientist reported that there was no difference in the label accuracy between products having undergone a third-party verification. In other words, as a whole, these "independent" certifications are meaningless. The report deliberately did not name names so it's not clear if USP is among the offenders, but without further evidence I would assume that it is.
posted by biogeo at 4:22 PM on April 16 [2 favorites]
The role of Orrin Hatch (and Tom Harkin, he is also responsible and doesn't get absolved just for being a Democrat) in passing the DSHEA is also discussed in detail in the "Alex Jones" link.
But it's important to keep in mind that this isn't entirely due to powerful interests and DC lobbyists. The DSHEA, despite being obviously and viciously anti-consumer, was overwhelmingly popular. I believe it was at its time, and perhaps still remains, the issue that prompted the most number of people to contact their congressional representatives in support, in all US history. More than many laws that govern us, the American people chose this one, despite what should have been obvious consequences. It's shameful.
posted by biogeo at 4:36 PM on April 16 [7 favorites]
But it's important to keep in mind that this isn't entirely due to powerful interests and DC lobbyists. The DSHEA, despite being obviously and viciously anti-consumer, was overwhelmingly popular. I believe it was at its time, and perhaps still remains, the issue that prompted the most number of people to contact their congressional representatives in support, in all US history. More than many laws that govern us, the American people chose this one, despite what should have been obvious consequences. It's shameful.
posted by biogeo at 4:36 PM on April 16 [7 favorites]
Also, I was aware of Jen Gunter but did not realize her substack is called "The Vajenda" and it is amazing. That logo!!
posted by biogeo at 4:38 PM on April 16 [2 favorites]
posted by biogeo at 4:38 PM on April 16 [2 favorites]
the American people chose this one, despite what should have been obvious consequences.
There are two different things going on here, though. One is the ability to take untested or unregulated substances, e.g., i should be able to take 300mg of crushed ladybug wings if I want to. The second is the quality and or purity of those ingredients.
The first is open to debate, the second should not be, and there should be serious penalities for violating the producer/consumer contract implied by the labeling.
posted by CheeseDigestsAll at 4:44 PM on April 16 [8 favorites]
There are two different things going on here, though. One is the ability to take untested or unregulated substances, e.g., i should be able to take 300mg of crushed ladybug wings if I want to. The second is the quality and or purity of those ingredients.
The first is open to debate, the second should not be, and there should be serious penalities for violating the producer/consumer contract implied by the labeling.
posted by CheeseDigestsAll at 4:44 PM on April 16 [8 favorites]
Supplements are consumed by 70% of U.S. military service members
The US Military Dietary Supplement Use Study was a random sample of military service members who completed a survey on supplement use and adverse effects experienced.posted by spamandkimchi at 5:54 PM on April 16 [1 favorite]
The questionnaire listed 96 generic dietary supplements as well as 67 named products. The branded products were identified by looking at dietary supplements sales directly to service members and also by surveying General Nutrition Centre stores on or near military installations.
... Over 10% of users reported adverse effects for 89% of weight loss products, 83% of pre/post workout products, and 53% of “prohormone” products. Adverse effects were most commonly reported with combination (“muscle building”) products.
Well, I'd argue that what's at stake is not whether you can take 300mg of crushed ladybug wings if you want to, but whether someone should be allowed to market and sell crushed ladybug wings to you as a "health supplement" with no evidence. People should mostly be able to put what they want into their bodies, but as you point out, there is a producer/consumer contract implied by marketing and labeling. After the Pure Food and Drug Act (1906) but prior to the DSHEA (1994), that implied contract included that the labeling and marketing of a product would not lie about what it can do, but since the DSHEA it now is as you say, only that the product should actually contain what it claims to contain (but also per the DSHEA there is no way of meaningfully enforcing that contract).
Perhaps it is debatable whether manufacturers and marketers should be allowed to lie for profit, but I think the consequences have proven to be pretty bad for us all.
posted by biogeo at 6:14 PM on April 16 [2 favorites]
Perhaps it is debatable whether manufacturers and marketers should be allowed to lie for profit, but I think the consequences have proven to be pretty bad for us all.
posted by biogeo at 6:14 PM on April 16 [2 favorites]
Sorry, fact checking myself: I think it was actually the Federal Food, Drug, and Cosmetic Act (1938) that established that sellers couldn't make false medical claims in their marketing/labeling. Also, this was never universal: homeopathic preparations were still allowed to make medical claims without evidence. The Pure Food and Drug Act just established that things had to contain what they claimed to contain, the DSHEA essentially returned us to that state of affairs.
posted by biogeo at 6:41 PM on April 16 [1 favorite]
posted by biogeo at 6:41 PM on April 16 [1 favorite]
Per the first linked article by Jen Gunter, a GAO scientist reported that there was no difference in the label accuracy between products having undergone a third-party verification. In other words, as a whole, these "independent" certifications are meaningless. The report deliberately did not name names so it's not clear if USP is among the offenders, but without further evidence I would assume that it is.
This may be splitting hairs, but the GAO report found that while the “third-party” verified prenatals didn’t have the exact levels of each vitamin/mineral, they were ballparkish. What I would like to see is if USP labeling at least good for verifying that what is in the capsule/tablet is what it says it is. It makes sense to focus on the best selling brands, but what would a wider range of brands look like?
posted by lizjohn at 7:31 PM on April 16 [1 favorite]
This may be splitting hairs, but the GAO report found that while the “third-party” verified prenatals didn’t have the exact levels of each vitamin/mineral, they were ballparkish. What I would like to see is if USP labeling at least good for verifying that what is in the capsule/tablet is what it says it is. It makes sense to focus on the best selling brands, but what would a wider range of brands look like?
posted by lizjohn at 7:31 PM on April 16 [1 favorite]
Coincidentally:
The council’s action follows recent reports of a massive rise in accidental ingestions of melatonin by children and an April 2023 study that found 25 products labeled as melatonin gummies contained dangerous levels of the hormone. One over-the-counter product contained up to 347% more melatonin than listed on the label, while another contained no melatonin at all — it was entirely composed of cannabidiol or CBD.posted by clawsoon at 7:33 PM on April 16 [3 favorites]
It's scary enough being pregnant, messing around with prenatals is just unconscionable. You don't realize how delicate the body really is until you are pregnant.
posted by subdee at 7:27 AM on April 19 [1 favorite]
posted by subdee at 7:27 AM on April 19 [1 favorite]
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posted by spamandkimchi at 12:41 PM on April 16