As the accumulating evidence against the indiscriminate use of vitamins, minerals, herbals, and other concoctions continues to gather, a widening chasm between vitamin supplement supporters and advocates for more cautious evidence based approaches has widened to alarming proportions.
The expanding disconnects between what is actually known about vitamin, mineral, and herbal supplementation (to mention but a few) and the publics’ eager willingness to buy them- surpassing a whopping $21 billion in 2005- illustrate their broad unfettered popularity. Indeed there is a widespread sentiment and ingrained confidence that vitamins and supplements in general are safe, essential, and effective tools for a healthier lifestyle.
The nutritional supplement industry and their advocates, not to be out done by the often aggressive public outreach of pharmaceuticals, have managed to create what is amounting to be an illusory need- that indiscriminate vitamin and mineral supplementation to the whole population is necessary and vital.
Since the days of Adelle Davis in the early seventies there has been an explosive and fairly uncontested stream of positively biased propaganda proselytizing the need for nutritional insurance through an ever more complex maze of supplements. So much so that it is now firmly cemented, not as the urban legend it should be, but as fact burned into the fabric of an ignorant public’s general consciousness.
A recent Harris poll found “69 percent of Americans believe the government requires herbal manufacturers to report side effects of there products, 58 percent believe the FDA must approve herbal products, and 55 percent believe that manufacturers can not make claims for their safety or efficacy without firm scientific evidence.” However, unlike other industries that have some type of regulatory structure and forms of accountability, the world of supplement companies has a comparatively free ride. In fact, since succeeding in pushing the Dietary Supplement Health and Education Act of 1994 (DSHEA), the FDA has been virtually powerless to effectively regulate supplements. The industry has not looked back since.
A 1999 and 2000 National Health and Nutrition Examination Surveys conducted on 4,862 adults found that 35 percent regularly used a multi-vitamin. Another 1991 survey, the national Maternal-infant Health Survey involving 8,285 pre-schoolers, found that 54.4 percent of them were given a daily vitamin or mineral supplement. Even today, in spite of a more tarnished scientific image, the public seems to unwaveringly support the idea of a perceived need for nutritional dietary supplements.
A recent 2004 survey found that 78 percent of US adults still somewhat or very confidently believed in the safety, quality, and effectiveness of supplements in general. These numbers seem to be supported by the amount of available supplements everywhere as food markets, specialty stores, and the Internet literally burst with a plethora of different dietary supplements that claim to effectively “promote”, “stimulate”, or “prevent” what your heart desires.
Yet, in the last twenty two years, the American Association of Poison Control Centers (AAPCC) received a total of 1,534,232 reports of adverse reactions to dietary supplements 235,879 of which required hospitalization. This is staggering enough-especially for a basically unregulated product- but according to Alexander Walker MD, chairmen for the department of epidemiology at the Harvard School of Public Health, in a 2000 study prepared for the FDA “A best estimate is that less than one percent of serious adverse events caused by dietary supplements is reported to the FDA.” Interestingly, since the passage of the 1994 DSHEA poisoning incidents related to vitamins and minerals increased by 62 percent whereas all types of poisonings grew just 24 percent.
These facts seem to get lost in the file drawers of the public consciousness as the billion dollar vitamin behemoth plies their wares with very little oversight and practically no accountability. The Federal trade Commission put together a set of guidelines regarding dietary supplements in 1998, however because of the 1994 DSHEA enforcement is very limited.
A 2000 Food Safety Report regarding the safety of functional foods and dietary supplements noted these problems and concluded that “FDA’s efforts and federal laws provide limited assurances of the safety of functional foods and dietary supplements. While the extent to which unsafe products reach consumers is unknown, we believe weakness in three areas of the regulatory system increases the likelihood of such occurrences. First, potentially unsafe products may reach consumers for a variety of reasons, including lack of a clearly defined safety standard for new dietary ingredients in dietary supplements. Second, some products do not have safety-related information on their labels, which could endanger some consumers. This occurs because the FDA has not issued regulations or guidance on the information required…. Finally, FDA cannot effectively assess whether a functional food or dietary supplement is adversely affecting consumers’ health because…it does not investigate most reports it receives of health problems potentially caused by these products.”
Efforts are underway to get a better grip on this monumental problem such as the FDAs’ Center for Food Safety and Applied Nutrition (CFSAN) work on developing a system for tracking and analyzing adverse events involving foods, cosmetics, and dietary supplements. Additionally, in 2006 the Government Reform Committee became more involved in considering issues regarding regulating the dietary industry more effectively. The NIH also released a statement "Multivitamin/Mineral Supplements and Chronic Disease Prevention" in 2006 discussing the inability of being able to make any recomendations regarding multivitamins and mineral supplementation due to a lack of evidence and the need further study.
Though these efforts go some of the way towards ensuring an improved product, real inroads towards ensuring efficacy and safety continue to be hampered by the now infamous 1994 DSHEA.
In the meantime, the public continues to avidly consume an ever increasing pallet of dietary supplements blissfully ignorant of these immense problems swallowing hook, line, and sinker the questionable advice and recommendations of an industry “gone wild”.
Hurley, D. Natural Causes. The Doubleday Broadway Publishing Group, New York. 2006