Healthwashing

Supplements manufacturers market untested benefits while avoiding real-world risks

Last Monday, I wrote about supplements manufacturers using “free speech” to push back against regulators trying to enforce labeling laws on their products—a trend that continues today, albeit often from influencers who somehow argue 1st Amendment rights are an antidote to the “problem” of vaccines.

As I noted, manufacturers often pretend their products are both benign (as in, doing no harm) and healing (as in, biologically beneficial). But these products are anything but benign, and have led to real-world harm.

Here are a few examples:

• A 1996 study of 18,000 people showed that people exposed to asbestos who were taking megavitamins with large doses of vitamin A and beta-carotene were 28 percent more at risk of developing lung cancer and 17 percent more at risk for developing heart disease.

• A 2004 study in Copenhagen conducted 14 randomized trials with 170,000 people and discovered that those taking large amounts of vitamins A, C, E, and beta-carotene were more likely to develop intestinal cancer.

• A 2005 study at John Hopkins School of Medicine performed a meta-analysis of 19 studies with over 136,000 people. Those taking megavitamins were at an increased risk of early death.

• Another 2005 study of 9,000 people found increased risks of cancer and heart disease in those taking large doses of vitamin E.

• A 2011 study at the Cleveland Clinic involving 36,000 men found a 17 percent increased risk of prostate cancer in those consuming vitamin E and/or selenium.

I understand the frustration around “Western” medicine. Americans have to suffer a for-profit medical industry that favors the wealthy and drains the savings accounts of the middle and lower classes, putting millions in debt—currently over 23 million Americans owe some form of medical debt. Citizens are collateral damage in an ongoing trilateral war between pharmaceutical companies, insurance companies, and hospital systems, with lobbyists from each constantly pulling and pushing regulators in every direction except the one that leads to socialized medicine.

My wife and I have just switched to our sixth insurance provider in under four years. We’ve lost thousands of dollars since the pandemic began due to deductibles alone. I’m as frustrated at our government’s flaccid response to regulating medical pricing in favor of its citizens as anyone else. Yet I’m also perturbed by an “alternative” health industry that capitalizes on people’s confusion and fears around science and medicine, and profits from their willingness to believe in untested and often unfounded health claims.

The modern supplements surge is in large part thanks to a fawning 1992 Time cover story that waxed poetic on the luminous benefits of megavitamins. Terms like antioxidants and free radicals entered the public vernacular. Studies showed that diets filled with antioxidant-rich fruits and vegetables resulted in better health outcomes. Supplements manufacturers ran with this narrative.

Pediatrician Paul Offit wrote about the mindset at the time:

If fruits and vegetables contain antioxidants—and people who eat lots of fruits and vegetables are healthier—then people who take supplemental antioxidants should also be healthier.

Isolating minerals and vitamins from food sources is not the same thing as eating the foods that provide those benefits. Organic interactions in foods likely provide those benefits. Removing them and increasing their quantity doesn’t equate to better health. Too much is often too much. The dose makes the poison, and yes, what starts as healthy can turn deadly.

Adapting to marketing

We recently covered Andrew Huberman, focusing on AG1 (formerly known as Athletic Greens). Since that episode I’ve looked deeper at their marquee product. 

Huberman’s endorsement of AG1 fits a common pattern I’ve often noticed, and which AG1 uses all over its marketing website:

• Identify a study. Doesn’t matter if it was a pilot study or only conducted on animals. If it fits a narrative that suits your conclusion, use it.

• Discuss the study’s broad parameters and focus on what the listener lacks: in this case, a vitamin or mineral, even something more aspirational that can’t be quantified, like “living your best life” or “tapping into more energy.”

• Use this lack as motivation for claiming that you need this particular substance or product.

• Make it seem as if this substance or product will fill that lack in your health “stack.”

Thus, Huberman makes statements like,

I’ve been using AG1 since 2012 because it’s the simplest, most straightforward way for me to get my basis of important vitamins, minerals, and probiotics.

After he became a scientific advisor to AG1 in 2022, he said,

Athletic Greens is transforming how people around the world approach nutrition through an extraordinarily simple and comprehensive daily habit… The comprehensive blend of ingredients with well researched benefits offers the most convenient way to invest in your nutritional foundation and complement a healthy lifestyle.

Here’s the thing: the “comprehensive blend” hasn’t yielded “well researched benefits” because AG1 has never been researched. Individual ingredients have been studied—with varying levels of success—but that’s not how AG1 positions its product. But it’s a slick spin.

Since AG1 can make health claims without testing, they’re relying on research on the massive list of ingredients. AG1 is composed of four proprietary blends: a “superfood complex,” an antioxidant stack, a mushroom complex, and two probiotic strains. 

The National Institute of Health (NIH) spent $2.4 billion studying vitamins and supplements and discovered they don’t do much—except potentially cause negative health outcomes.

Harvard Medical Schools' Dr Pieter Cohen writes,

During the past 2 decades, a steady stream of high-quality studies evaluating dietary supplements has yielded predominantly disappointing results about potential health benefits, whereas evidence of harm has continued to accumulate.

AG1 raises similar medical concerns as those identified by the NIH. Breaking down all 75 ingredients would require many articles, so let’s consider three adaptogens included in the pouch. 

Adaptogens are mushrooms, plants, herbs, and roots that are supposed to help us adapt to and manage stress. This is a particularly potent message in today’s world, where anxiety and stress levels are off the charts. Dropping a herbaceous blend of plant life into a mug seems like a more natural means for dealing with life’s stressors, a fact that companies like AG1 exploit. On its face, plant-based diets are healthy. Taking the step from generally healthy to specifically beneficial for this or that ailment is the leap many companies decide to take. 

Adaptogens have the misfortune of interacting with a range of medications. AG1’s adaptogenic blend includes dandelion, which interacts with diuretics, diabetic medications, lithium, and some antibiotics; ashwagandha, which interacts with benzodiazepines, immunosuppressants, diabetes medications, and antihypertensive drugs; and rhodiola, which interacts with antidiabetic drugs, antihypertensive drugs, and immunosuppressants; it can also affect how the liver and body breaks down certain medications. None of these potential interactions are listed on AG1’s website. 

Instead, you’ll read marketing copy like,

Traditional herbalists have prescribed dandelion as a ‘cooling digestive tonic’. Dandelion root has been linked to digestive aid, cardiovascular health, liver and gallbladder health, and urinary support.

Is this true? A 2022 review found that anti-inflammatory and anti-oxide active substances in dandelion could provide some relief from GI disorders, but cautioned that “research related to GI protective dandelion-derived products remains limited.” How about cardiovascular health? While there have been promising results in a few in vitro and in vivo studies, another 2022 review concluded that “the evidence base is insufficient to unequivocally confirm whether dandelion and its products have beneficial effects on hemostasis and CVDs, especially in humans.” The same holds true for liver and gallbladder health: early positive evidence in animals, not so much in humans. As for urinary support, a 2009 study found that dandelions might act as a diuretic, though the study was conducted on one day and used only 17 volunteers. Companies tend to overlook the qualifying “more research is needed” when boasting about perceived benefits.

More from AG1:

Ashwagandha is an awesome adaptogen. This means it’s part of a class of herb that can help you adapt to stressful situations. Ashwagandha has been used for many years as part of natural Ayurvedic medicine and luckily the western world is now starting to catch on.

The copy isn’t wrong that ashwagandha has become one of the most popular adaptogens on the market. A staple of Ayurvedic practice, there’s been a good amount of research on the powder from this evergreen shrub. Small studies have shown that doses ranging from 250 mg to 600 mg of ashwagandha extract reduced perceived stress levels, while another small study of volunteers taking 240 mg of extract had reduced anxiety. Yet a 2021 review wasn’t so optimistic, noting that many common extracts contain up to 95% of “uncharacterized materials” while also stating that ashwagandha’s many medication interactions should be studied in more depth.

Problematically, AG1 doesn’t list the amount of ashwagandha included in its proprietary blend, making it impossible to rely on the above studies for confirmation of its stress-reducing qualities.

Last one:

Rhodiola is an adaptogen that helps the body ‘adapt’ to stress. One theory on how adaptogens work is ‘hormesis’ - small stressors stimulate the body positively, prompting it to react, adapt, and become stronger.

Of all the claims listed so far, this herb is on better standing: a 2017 study featuring 117 volunteers ingesting 400 mg of rhodiola for 12 weeks yielded positive results in treating stress-related burnout. Unfortunately, there was no control group, making it difficult to attribute the decreased stress to rhodiola alone. And since AG1 doesn’t list the dose on packaging, you can’t be sure you’re receiving enough to actually make a difference—or ingesting so much that it can negatively interact with medications you might be on.

The naturalistic fallacy is the false notion that because something is natural it must be good for us. This is an error in thinking, not a representation of reality, and predominantly speaks to our hubris as animals with consciousness. One dose heals and another kills—Paracelsus knew this 600 years ago. But the fallacy persists. 

And so we’re going to have to continue wading through a broken healthcare system with perverse incentives and a broken dietary supplements industry. If you’re on medications, you have to do the legwork to discover if any of the vitamins or minerals interact with your medication, and even then, you have no idea if the dose matters in that interaction, at least on these mega-multi-vitamin protocols.

This isn’t about freely speaking about what you think may or may not work. It’s about taking responsibility for those words, and as we’ve seen, too many companies only do that when forced to by a court of law, and even then, they keeping going.