Like Lifting Up the Floorboards and Finding an Oil Well That’s Ready to

May 28, 2024 3:54 AM

The Money In Menopause Supplements I created Dr. Jen's Menopause Taming Turmeric Supplements to find out just how much. As influencers and podcasters all suddenly have their own menopause supplements, OBGYN Dr. Jen Gunter went through the steps of getting quotes to do the math on just how profitable selling a cheap turmeric pill with good marketing and no science can be. (Please note: She is not a crook. She is not selling anything. She just did the math.)

Follow-up: The Trouble with Turmeric A deep dive into the most popular spice/supplement be marketed without a shred of evidence that it is effective in its natural form, which is barely absorbed in the body, or that it is safe in forms that enhance absorption, when it seems to be pretty bad for your liver.

posted by hydropsyche (51 comments total)

CW: contains discussion of the "liver condom." Which is apparently a thing.
posted by Halloween Jack at 4:30 AM on May 28

"Five patients were hospitalized, and 1 patient died of acute liver failure.
...Turmeric was used for a median of 86 days before onset of injury with laboratory abnormalities ...
Clinical Significance
...Liver injury due to turmeric appears to be increasing reflecting usage patterns and combination with black pepper, which increases its absorption."
i've occasionally used it as food coloring, fortunately avoiding pepper; will be more circumspect henceforth. thanks
posted by HearHere at 4:33 AM on May 28 [1 favorite]

From the article:

Selling bespoke menopause supplements isn’t championing women; it’s cashing in on the menopause gold rush.

....And the reason for said gold rush is that scores of women go through menopause, but the medical community has done very little to study it. Not all of us want to go through HRT but there's nothing else out there because no research.

Grr.
posted by EmpressCallipygos at 4:49 AM on May 28 [31 favorites]

I guess I should mention my tea for men with nipples.
posted by parmanparman at 5:02 AM on May 28 [9 favorites]

there's no research

There are new non-HRT molecules coming on the market to help with vasomotor/hot flash symptoms. One is already available and the other is finishing clinical trials with positive results. Unfortunately, they won't be cheap.
posted by JoeZydeco at 5:04 AM on May 28 [1 favorite]

There are men without nipples?
posted by 2N2222 at 5:06 AM on May 28 [2 favorites]

Honestly, Dr. Gunter’s book on menopause should be required reading for any folks who will or are experiencing menopause.
posted by Kitteh at 5:07 AM on May 28 [11 favorites]

Fascinating and informative. Thank you so much for sharing!
posted by brainwane at 5:19 AM on May 28

She is one of my heros. And not just for this.
posted by atomicstone at 5:40 AM on May 28 [3 favorites]

I guess I should mention my tea for men with nipples.

There are men without nipples?

There's tea with nipples?
posted by chavenet at 5:41 AM on May 28 [19 favorites]

If hepatoxicity is a real risk from turmeric supplements, shouldn't we be seeing much, much more of it, given how popular it is, especially the formulation with piperine?
posted by mittens at 5:45 AM on May 28 [2 favorites]

how would we know? through what reporting mechanism? there isn’t one. there’s also probably a range of liver damage even harder to capture.
posted by knock my sock and i'll clean your clock at 5:48 AM on May 28 [9 favorites]

There are men without nipples?

Someone has to have claimed that band name by now.
posted by delfin at 6:21 AM on May 28 [5 favorites]

There's tea with nipples?

I love a little body horror with my breakfast,
posted by thivaia at 6:22 AM on May 28 [5 favorites]

Using turmeric in its relatively natural form isn’t the issue for most people, it’s the extracts (high bioavailability) that are in supplements, combined w black pepper extract that have been popping up as dangerous. Like, use it as a spice (especially without black pepper) and you’re ok unless you have other issues. (When I was pregnant and having issues it did go on the no list; I also had a liver issue in my early 20s.) Lots of traditional recipes include yummy turmeric.

Jen Gunter is amazing. I love this piece because it really highlights the “why” part of the snake oil that are supplements + social media/podcasts/etc.
posted by warriorqueen at 6:27 AM on May 28 [5 favorites]

Now I'll have David Warner's voice in my head saying, "Nipples for men?" all day.
posted by Ickster at 6:28 AM on May 28 [4 favorites]

There's tea with nipples?

nice cuppa titley..... i mean tetley?
posted by lalochezia at 6:34 AM on May 28 [10 favorites]

Using turmeric in its relatively natural form isn’t the issue for most people, it’s the extracts (high bioavailability) that are in supplements, combined w black pepper extract that have been popping up as dangerous.

Which is, of course, the whole issue. Anyone who claims that "I have cracked the code of human biology and nutrition, and if you isolate this one tiny bit of an everyday diet or this one naturally occurring component and consume it in mass quantities, you will live forever" is selling something, and it ain't something that will benefit anyone but the seller's checking account.

As Dr. Gunter rapidly found that she could've.
posted by delfin at 6:43 AM on May 28 [5 favorites]

She explains in the article how tumeric in food is fine because very little gets absorbed as a supermarket available spice. The tumeric you got in a capsule is a huuuuge amount and often treated to make it ‘more’ effective. So like a pinch of salt on a meal vs a tablespoon eaten directly.

Dr Gunter’s science writing is a joy. She walks you through research in clear language, cites her sources and is often very very angry.

One line in there I liked was that women deserve good quality data too.
posted by dorothyisunderwood at 6:46 AM on May 28 [15 favorites]

Man, there are so many businesses I've run across where I'd be pretty rich today if:

1. I have a lot of startup money
2. I am fine with lying a lot

posted by AzraelBrown at 6:49 AM on May 28 [19 favorites]

I can't think of turmeric without thinking of this McLennan and McCartney sketch.
posted by RonButNotStupid at 6:55 AM on May 28 [8 favorites]

Can now only think of Marc Maron's you never know when someone’s gonna dump some shit into your head that’s gonna ruin your life bit about turmeric
posted by scruss at 7:00 AM on May 28 [7 favorites]

No wonder the MAGAverse is so oddly full of supplement ads.
posted by aramaic at 7:32 AM on May 28 [3 favorites]

Turmeric is sometimes adulterated with lead chromate to enhance the color, I wonder if this plays a role in the hepatotoxicity.
posted by grokus at 7:42 AM on May 28 [8 favorites]

Absolutely. Almost every right-wing grifter sells supplements because there is every little oversight and the claims are impossible to disprove. The pitches are kind of terrible, too -- Alex Jones was hawking something where the selling point was that it would give you painful erections. Now, to be fair, he sounded distracted and/or drunk, so maybe that wasn't the feature he really wanted to emphasize, but... he's still selling it.

Honestly, if all this turmeric talk would get people to eat more yummy curries, I would be all for it. Sadly, we don't live in that world.
posted by GenjiandProust at 7:44 AM on May 28 [4 favorites]

MetaFilter: will be more circumspect henceforth.
posted by pracowity at 7:55 AM on May 28 [3 favorites]

CW: contains discussion of the "liver condom." Which is apparently a thing.

Braunschweiger casing
posted by fluttering hellfire at 8:12 AM on May 28 [5 favorites]

If hepatoxicity is a real risk from turmeric supplements, shouldn't we be seeing much, much more of it, given how popular it is

The fun thing about livers is that they fail very slowly and it's very quiet until it isn't, and if you don't have the kind of healthcare that you're getting routine yearly bloodwork to track it you really don't know, and symptoms - if there are any - are so vague that they maybe register is a slight bit extra fatigue or a little bit of digestive trouble. And some kinds of liver toxicity will, if consumption stops, be reversible or mostly so because livers are pretty amazing, but some damage is forever.

You can walk around for a very long time with a mostly-wrecked liver and not know until suddenly you need an emergency room.

But also there's not really a national database of Crappy Livers. Individual medical professionals, in my experience, are so far around the cynical bend that getting even cancer diagnosed is often complicated by doctors saying to just go on a low fat diet and stop drinking, whether you drink or not.
posted by Lyn Never at 8:27 AM on May 28 [18 favorites]

This is insane.

...so, let me get this straight. I could:
1) "accidentally" optimize a supplement for hepatotoxicity
2) market it to my political enemies
3) laugh all the way to the bank
4) suffer no consequences aside from the moral injury, especially if I was smart enough to do everything offshore?

This seems like something a society might want to prevent.
posted by aramaic at 8:27 AM on May 28 [7 favorites]

There are men without nipples?

Men can get breast cancer, so...
posted by Halloween Jack at 8:29 AM on May 28

Turmeric is sometimes adulterated with lead chromate to enhance the color, I wonder if this plays a role in the hepatotoxicity.
from the second article "Contamination with lead or dyes as a cause of the liver injury has been ruled out, so it seems to be the curcumin."
posted by HearHere at 8:37 AM on May 28 [3 favorites]

(also, if any of you run into a supplement that seems specifically aimed at leftists, you should probably not take it)
posted by aramaic at 8:41 AM on May 28 [4 favorites]

You don't even have to put anything in the pills you sell. See all the branded placebo pills on Amazon for over $20 a bottle - "Pure Honest Placebo Tablets Designed to Help You Access Your Mind's Potential". At least they won't poison you.
posted by ShooBoo at 9:14 AM on May 28 [8 favorites]

I want to draw greater attention to the scientific fraud that has led to millions of wasted dollars researching turmeric. We generally assume that people in science are operating in good faith and that the peer-review process will weed out poor studies. However, there is a lot of bad faith actors out there, falsifying data, studies, statistics, you name it, in order to publish because "publish or perish", or respect/esteem, or "everyone is doing it", or lack of understanding of the rigor that science needs to work, or reasons I can't think of. Anyway, check out Retraction Watch
posted by lizjohn at 9:19 AM on May 28 [4 favorites]

MetaFilter: will be more circumspect henceforth.
Promises, promises.
But yeah, I've been taking turmeric/black pepper supplements for osteoarthritis and I think I'll stop now.
posted by The Ardship of Cambry at 9:30 AM on May 28 [4 favorites]

You don't even have to put anything in the pills you sell. See all the branded placebo pills on Amazon for over $20 a bottle

Given all the impurities and mislabeling rampant in the supplement industry they’re probably full of Ozempic.
posted by Horace Rumpole at 9:58 AM on May 28 [4 favorites]

I so much appreciate Dr. Jen Gunter speaking up about this. A couple of internet searches on perimenopause stuff and I am AWASH in social media marketing for all kinds of sketchy supplements. And as someone who can't take take HRT even if I wanted to b/c of a previous breast cancer diagnosis, my actual medical advice (once HRT is off the table) has been nonexistent. It's just bonkers out there.
posted by pantarei70 at 10:08 AM on May 28 [9 favorites]

She explains in the article how tumeric in food is fine because very little gets absorbed as a supermarket available spice. The tumeric you got in a capsule is a huuuuge amount and often treated to make it ‘more’ effective. So like a pinch of salt on a meal vs a tablespoon eaten directly.

How big are those capsules? Because when I cook with turmeric, I go with tablespoons not pinches, the stuff is good in many recipes, and I do love curries very much.

Fuck it, since nobody in India seems to be dropping down from it, I'll assume having it in food is ok.
posted by WaterAndPixels at 10:38 AM on May 28 [1 favorite]

I so appreciate Dr. Gunter's writing and her substack, esp these days as everything in my feed (as I'm the right age) seems to be either how HRT is a miracle cure for all that ails me or some supplement for sale. More than once I've gone to her articles to look up something about HRT only to find she has much more conservative tempered opinion for symptom X than many an internet personality preaches. I had been listening to Dr. Haver recently and liked what she said but when I went to her website and saw that she was selling supplements it gave me such pause. (I had kind of been wondering if/when a Gunter/Haver showdown might occur, I didn't expect it to be b/c of tumeric but it makes sense given how passionate Gunter is about taking down junk products designed at women).

This stat was sobering: It’s concerning that over $150 million in American taxpayer dollars later, we still don’t have good data for curcumin. In 2022, endometriosis received $27 million in NIH funding, but it has traditionally been much lower than that. It’s hard to play research favorites, but it’s also hard to see money go to support funding for a molecule that has resulted in less than spectacular results, and yet we still don’t understand the basic biology of a disease that affects 10% of women.. We need to do better for women's health.
posted by snowymorninblues at 12:08 PM on May 28

No wonder the MAGAverse is so oddly full of supplement ads.

It goes back further: How A 1994 Law Supercharged Utah's Supplement Industry.
posted by Slothrup at 12:45 PM on May 28 [4 favorites]

Besides the liver condom did anyone else notice this: "... green tea extract, an ingredient in the product, is associated with liver injury."? Although it's fine if you only drink it, concentrated it's a whole 'nother story. It's just one of the ingredients you can easily buy that can harm you and there's really no oversight. There's a lot about the supplement industry that should scare you.
posted by tommasz at 1:20 PM on May 28 [1 favorite]

How big are those capsules? Because when I cook with turmeric, I go with tablespoons not pinches, the stuff is good in many recipes, and I do love curries very much.

Fuck it, since nobody in India seems to be dropping down from it, I'll assume having it in food is ok.

From the second article:

For a substance like turmeric to provide medicinal value beyond the gut, it must be absorbed into the blood. When ingested, about 99% of turmeric remains in the gut and heads out of the body with stool. This means that almost none of it gets into the blood, which also means that turmeric in reasonable doses is nontoxic, although adulteration with lead can be a concern with turmeric spice and turmeric supplements (which are much higher amounts than used in cooking). Contamination with lead can come from the soil where the turmeric is grown, or turmeric/curcumin can be purposely adulterated with lead chromate to enhance the yellow color

More info below that explaining how people are increasing its absorption and the damage to your iron levels and liver that can result.
posted by hydropsyche at 1:52 PM on May 28 [1 favorite]

For interesting and infuriating listening, This Podcast Will Kill You just covered supplements.
posted by gingerbeer at 2:22 PM on May 28 [3 favorites]

....And the reason for said gold rush is that scores of women go through menopause, but the medical community has done very little to study it. Not all of us want to go through HRT but there's nothing else out there because no research.

There is actually a fuck ton of research on estrogen and estrogen deficiency in women and animals and it's fucking grim. At every corner, estrogen protects against so many diseases of aging and the brain. And the medical community is all like whoops but tiny increase in cancer?! Also clot risks because we haven't (as you said) done much to improve formulations and delivery methods since the stone ages or if we do, our doctors still prescribe the old stuff.

Women's bodies are silly with estrogen receptors. Women age RAPIDLY when we are depleted of estrogen. We lose the neuroprotection of estrogen which helps prevent oxidative stress, we have altered reward processing in the brain. Collagen production slows down and our joints and tendons start to fail at faster rates and repair themselves poorly when damaged. Cardiovasicular disease spikes because OUR BLOOD VESSELS HAVE ESTROGEN RECEPTORS. These receptors help modulate vasodilation through the nitric oxide path. And that's just idk a few things that are bugging me today.

Post-menopausal women will have a lower level of estrogen than their male counterparts. Let that sink in. We are at a disadvantage with health outcome to our male peers after menopause because of all around reduced gonadal hormones. Even though our testosterone goes up, it doesn't match that of men or act as a replacement to lost estrogen.

I like Jen Gunter, and I've laughed with an Indian friend about the crazy price of turmeric supplements. I've agreed with a lot of the wild nonsense out there for women who are peri/menopausal and how there are a ton of practitioners that are taking advantage of desperate women with bad science.

The place I really don't like Jen Gunter is she doesn't acknowledge there is some legitimacy to where women are trying to bootstrap their health in the face of insufficient care and outdated information from the medical community. She's not wrong when she points out the lack of large, randomized trials for certain treatment modalities. But what am I and countless other women supposed to do when we know we don't feel right? When we're watching the negative effects of changing and deficient gonadal hormones on our own bodies and the data on how to fix it isn't there? We know that's the cause and that we need to do something about it before its too late (because of course, there is a fixed window here where averting the worst outcomes requires prompt action).

That's what I want to know and that's the question she pretends doesn't exist and thus why I have my cynicism towards her, too. I do agree the studies on estrogen replacement solving some of these isn't great and some show it doesn't help at all. But she, like my own doctor, doesn't have an answer or suggest even trying to address anything outside of vasomotor symptoms. Thanks, I'd like my brain, orgasm, blood vessels and joints to stay intact and if the medical community doesn't think that's a priority, then their gap is what's causing women to reach for the unproven and often harmful alternatives.
posted by [insert clever name here] at 5:20 PM on May 28 [11 favorites]

I'm sorry that has been your experience with her work. That has not been my experience of it at all. She began her most recent series on menopause hormone therapy last summer. I've found her extensive advice on different aspects of menopause hormone therapy to be highly nuanced and very much of the "if this is the problem, have you tried this" approach for a huge range of symptoms and health concerns, including advocacy for options like vaginal estrogen for sexual health.
posted by hydropsyche at 5:39 PM on May 28 [3 favorites]

That's what I want to know and that's the question she pretends doesn't exist and thus why I have my cynicism towards her, too. I do agree the studies on estrogen replacement solving some of these isn't great and some show it doesn't help at all. But she, like my own doctor, doesn't have an answer or suggest even trying to address anything outside of vasomotor symptoms. Thanks, I'd like my brain, orgasm, blood vessels and joints to stay intact and if the medical community doesn't think that's a priority, then their gap is what's causing women to reach for the unproven and often harmful alternatives.

If someone ends up performing a self harm because there is currently no efficacious treatment for a particular condition, as you point out yourself, can that really be blamed on the medical community? Especially in a case where the medical community specifically warns against some particular treatment/medication with a potential to cause harm in addition to inefficacy?
posted by 2N2222 at 7:45 PM on May 28

There are plenty of prescription drugs that very occasionally cause sudden and severe hepatotoxicity (“fulminant” is not an adjective you want to encounter in the wild) but unlike the turmeric supplements most of them do something more than hypothetically reducing your risk of cancer or whatever.
posted by atoxyl at 9:51 PM on May 28

My only gripe against Dr. Gunter is that she can get girlbossy sometimes, but for all of that, she really does want the best for those of us with ovaries etc. Women are often grossly underserved by the medical community even in the year of our Audre Lorde 2024. There is so much cruft for menopausal folks in terms of how to deal with our symptoms.

Another book I can absolutely recommend re: menopause is by non-binary author and artist, What Fresh Hell is This? I would especially recommend for those who happen to have female reproductive bits but do not identify as female.
posted by Kitteh at 8:01 AM on May 29

Where do we get these placebos?! [Simpsons clip]
posted by neuron at 11:10 AM on May 29

FYI on nipples: from my decades of experience in medicine, I estimate that about 1% of the population has 3 nipples. None of them know that their "mole" is an extra nipple. I don't think I've ever seen more than 3. (A quick look at Wikipedia suggests that human embryos potentially have as many as 16.)
posted by neuron at 11:31 AM on May 29

FYI on nipples: from my decades of experience in medicine, I estimate that about 1% of the population has 3 nipples.

I have 4 -- at my belt-line on the left and right, not quite directly below my normal nipples but similarly symmetrical, I have big "moles" which are supernumary nipples, basically the tip without areola.

When courting my now-wife, I brought it up as a fun fact about myself, but she did not find it nearly as amusing as I had hoped, and to this day she half-jokingly tells people that this incident almost ended our relationship. Some people have a "thing" against extra nipples.
posted by AzraelBrown at 6:02 AM on May 30 [1 favorite]