Sonu Shah, a Southern Californian mother of two, uses health supplements on a daily basis. “They give me energy, and keep me healthy so that I can take care of my two kids and husband,” she said. Shopping at Costco, she likes that she can pick up her supplements in bulk at a low price, along with her other groceries. “I don’t know what I would do without them,” she added. Shah echoes the feelings of nearly one hundred and fifty million Americans who constitute the over twenty-six billion dollar a year dietary supplement industry in the United States. And it is a market that’s on the rise.

Jeevan Zutshi, the author of the book, “The Last Smile,” cautions against falling victim to big company advertising. Zutshi’s son died of cardiomyopathy, or heart failure, from an overload of over-the-counter body-building supplements that left his heart devoid of the sodium it required. This led Jeevan to find out about the role of regulations in the dietary supplement industry, and the connection of pharmaceutical corporations to the supplement brands. Zutshi lost his young son to the fallacious reasoning that health supplements can improve health and his book raises questions on why there were not enough regulations to prevent the loss of life.

What Is a Health Supplement?

It could be something as common as Vitamin C, fish oil, probiotics, or something catered to a very specific audience, such as muscle-enhancement supplements and protein powders often sold at gyms. From weight-loss to sexual performance to memory enhancement, the supplement industry covers a wide audience with diverse products. However, this mostly unregulated market may prove to be more of a liability than an asset to the overall health of Americans because the untrained eye of this audience has failed to recognize a crucial distinction between two fundamentally different types of dietary supplements and the effects they have on the human body. This, combined with strong lobbying efforts by pharmaceutical companies, and the inefficiency of the Food and Drug Administration (FDA) has made the dietary supplement market a barrier to American health and well-being.

Supplements Won’t Fix a Crap Diet

On the Men’s Health discussion board, a member with the online moniker, CollegeStudent16, asked the question, “I am taking Vitamin C 500 mg, Flaxseed Oil 1300 mg, One a Day Mens, Calcium 600 mg w/ vitamin D, and Fish Oil 1000 mg. Is this a good variety of supplements to take everyday? Should I add or exclude any supplements?” The answer to this by the moderator of the site was succinct: “Supplements won’t fix a crap diet.”

Indeed, a cocktail of nutritional supplements is no substitute for healthy eating. The questions we should be asking are: Did this student consult a doctor? Does he know the side-effects of the additives he is absorbing? Does he know if any one drug reacts differently when taken with another? Has he read the labels?

When it comes to supplements, there is a big distinction between those that help the human body versus those that could have adverse effects. Benjamin Caballero, a professor of human nutrition at the Bloomberg School of Public Health, in an interview for the John Hopkins Magazine stated that supplements are harmless when used in a controlled way. Problems arise when health supplements are overused or are substituted for natural dietary intake. Supplements like Centrum are not dangerous, Caballero explains, “considering the doses of Centrum and all these typical multivitamin supplements. It’s just [producing] expensive urine.”

So what kind of supplements should we be taking? CNN Chief Medical Correspondent, Dr. Sanjay Gupta, says that he is in the habit of taking fish oil/omega 3 supplement since he has a family history of heart disease. As studies have shown South Asians are at a higher risk for heart disease, so does that mean we should all be taking fish oil/omega 3? Not so, indicates Gupta. “I know it is harder than it sounds but the best way to get nutrients is through a well-balanced diet.” So in other words, loading up on lots of vegetables, fish and leafy greens is the best way to keep your immune system up your heart pumping and your brain working at full speed.

Two Spoons a Day Help Keep Illness Away!

Most first generation Indian American immigrants have heard of the popular food supplement Chyawanprash, the oldest commercial brand of health supplement produced anywhere. The market size of Chyawanprash in 2010 was credited to be about 80 million dollars. Chyawanprash has 47 ingredients of which amla or the Indian gooseberry is the main one. Chyawanprash is touted to have anti-aging benefits and according to Wikipedia, it provides relief for cough, dyspnoea, fever, emaciation, heart diseases, arthritis, urinary problems, impotency and speech impediments and increases digestive power, intelligence, memory, complexion and it helps in bowel movements, gives strength to all sense organs, and increases sexual power. Wow! That’s quite a whopper of a remedy.

It is widely acknowledged in India that the formula of Chyawanprash was discovered by the sage Chyawan. The story goes that Chyawan married a beautiful and very young princess, but soon realized that the years between them would widen as he aged. So he looked heavenwards for a remedy. The celestial gods came up with the formula for Chyawanprash concocted for the explicit intention to make Chyawan young and strong again. Charak Samhita, the ancient Ayurvedic manuscript written by sage Charak in the 4th century BC has the first historically documented herbal formula for Chyawanprash.

But even in this heavily marketed nutritional supplement, ostensibly patented by the gods, there are ingredients that may not be as healthy as assumed. One is the artificial sweetener sucralose, a chlorinated version of sucrose that has been said to impact the kidneys, liver and the thymus gland. The other is sorbitol, which can cause gastrointestinal problems including irritable bowel syndrome.

Concentrated Food Supplements vs. Nutraceutical Supplements

Ronda Nelson, a naturopathic doctor in Redding, California, explains that the dietary supplement market constitutes of two fundamental types: concentrated food supplements and nutraceutical supplements. The former allows the body to liberally use what it needs, while the latter forces the body to act a certain way, much like a prescription drug would. Concentrated food supplements, as the name suggests, are made from food sources. Consuming supplements like Chyawanprash would be the equivalent of consuming the foods they come from, which is why the human body will treat them like food, taking what it needs and storing or discarding what it does not.

The nutraceutical supplements, however, are either made from, or laced with, chemicals, and so, just like prescription drugs, they force the human body to react in a certain way. This means that they have similar adverse side-effects.

Dr. Nelson entered the field of naturopathy after her daughter, Rachael, was diagnosed with Ewing’s sarcoma bone cancer. Not having any history of sickness or the cancer in the family, she was perplexed. She found that Rachael had previously broken her bone in the exact spot where the cancer had shown up. Rachael’s body never received the nutrition required to heal the bone, which caused her cells to mutate, leading to the rare cancer showing up in her body. This led Nelson to study alternative medicine and get her Ph.D. in Holistic Nutrition. But few can take the time or get educated enough to make the distinction between natural and synthetic supplements.

“A good number of Vitamin C supplements list ascorbic acid as an active ingredient. This means that they are nutraceutical supplements. Synthetic ascorbic acid is made up of high fructose corn syrup and sulfuric acid, both of which are terrible for your body” said Nelson. Most of the supplements sold over the counter are nutraceutical in nature, she stated, and thus bad for the human body. However, from a very early age, part of the disseminated education explains such vitamins to be a healthy means to supplementing one’s diet.

Distinguishing between natural and synthetic iterations of the same has become rather crucial to understanding benefits and effects. Consider synthetic Vitamin A supplements for a moment. Consumed by pregnant women, these were found to be responsible for birth defects according a University of Maryland Medical Center study. Yet no warning labels are affixed to these toxic supplements as they continue to sell alongside all the other nutraceutical supplements in stores nationwide.


The Last Smile

Shankey Srinivasan, a filmmaker out of the San Francisco Bay Area, is directing his newest film “The Last Smile” based on Zutshi’s book of the same name. Zutshi’s son Amit, was in his twenties when he became a casualty of the supplement industry. Though the doctor did not assign blame to the over-the-counter nutritional supplements Amit was taking, Zutshi believed it was definitely a factor. “Amit’s death could have been prevented had I known about his supplement usage. The doctors won’t share his medical records due to patient privacy issues and it was too late by the time we realized what had gone wrong. I want to make sure no other parent goes through such an experience. The current system is flawed and we, as responsible citizens and parents, must take steps to correct it,” said Zutshi in one of his conversations with Srinivasan.

Body Building Supplements

The growing use of body building supplements in the form of fat burners, muscle enhancers, energy supplements and protein powders is a heavily advertised, catered sector of the dietary supplement market. These supplements carry very shallow warnings to protect themselves, but rarely reveal what causes the human body to change. By listing “proprietary blend” as an ingredient, these companies often use steroids, creatine, diuretics and more to the detriment of their consumers.

The Mayo Clinic lists as side-effects to these ingredients the following: hair loss, infertility in men, cramping, diarrhea, dehydration, acne, liver abnormalities, tumors, emotional rage, kidney failure, heart failure, and more. With a population that already struggles with a variety of food-related health issues, the strain that these “supplements” add prompts the question “Is it worth it?”

Supplement Market Regulations

Over the course of reading through Zutshi’s book and researching its contents, Srinivasan found that there is a great deal of consumer naiveté and general misinformation when it comes to the purchase and consumption of body-building supplements. “Their customers look at ‘before’ and ‘after’ photos of a person–usually taken on the same day–to gauge the success of that product. This is a huge problem,” exclaimed Srinivasan.  The marketing efforts put into promoting these efforts would appear to have betrayed their customers’ best interests. But there is a bigger problem behind the scenes.

These nutraceutical supplements often avoid deeper probing by both consumers as well as the Food and Drug Administration (FDA) by claiming they utilize the aforementioned “proprietary blend” considered to be a trade secret. To force disclosure is very difficult, thanks to the Dietary Supplement Health and Education Act of 1994 (DSHEA). DSHEA was implemented to help regulate the supplement market as a growing health awareness had started sweeping through the United States. However, due to corporate lobbying efforts, this fell short of what it had hoped to do. With the burden of proof on the FDA, nutraceutical supplements ended up on the shelves of most grocery stores right next to the concentrated food supplements, making the same claims without any warnings for the consumers. This, of course, was beneficial to the pharmaceutical corporations that owned many of these supplement brands. Srinivasan found his motive for the movie in the big-money politics of this industry. “I found a very personal and emotional story of a father in the backdrop of corporate American greed that inspired me to write the screenplay for the film,” he said.

While it would be quite simple to blame the lobbyists–and the pharmaceutical corporations responsible for them–for this debacle the FDA is just as complicit in, and responsible for, the state of the health supplement market today. By actively not distinguishing between concentrated food supplements and nutraceutical supplements, the FDA sought to treat all health supplements as equal, which understandably resulted in chaos over regulatory consensus. Under DSHEA, the FDA describes a dietary supplement as “a vitamin, a mineral, an herb or other botanical, an amino acid, a dietary substance for use by man to supplement the diet by increasing the total dietary intake, or a concentrate, metabolite, constituent, extract, or combination of any ingredient [above].” This is a very convoluted definition, which is what allowed lobbyists to water down the bill, while maintaining a certain amount of ambiguity as to what a dietary supplement really is.

Lumping it Together

There would be little advantage to heavily regulating concentrated food supplements, yet that is essentially what the FDA called for when lumping natural supplements with synthetic ones. Ironically, the administration is responsible for the same treatment when it comes to food products. In 2010, for example, the FDA sent a warning letter to Diamond Foods, Inc. challenging a product label that stated their walnuts were a heart healthy choice. The company had to either change the label–to accurately reflect the FDA’s claims–or apply for their walnuts to be considered a drug. It is no wonder that such bureaucratic and burdensome regulations would face resistance, a recent example of which was the failed Proposition 37 in California.

The goal of this proposition was to label and identify genetically modified food items, but it was rife with inconsistencies. By allowing exemptions for alcohol, health supplements, meat and poultry that had been injected with genetically modified foods, food served at restaurants and other establishments, the proposition would have given people the illusion of being well-informed and healthy.

Nelson believes the solution is a grassroots approach to health education. She encourages and empowers her patients to make healthy eating decisions on a regular basis. “Support local farmers and ranchers by purchasing organic foods as well as grass-fed cattle and poultry,” says Nelson. Education is key to changing the American people’s daily decisions in regards to foods and supplements, she says.

The Good, the Bad and the Useless

According to CNN’s Sanjay Gupta there are some best-selling herbal supplements that fall in the concentrated food supplement bucket that are proven to have little benefit. Studies have shown that “gingko biloba” is virtually useless for memory improvement or to ward of Alzheimer’s disease, both benefits that the industry has been marketing. The popular “echinacea” is basically a dud and does little to fight off a cold and there is no evidence that “St. John’s Wart” works to treat depression.

“Not all supplements are bad, however, and some may be required for people with nutritional deficiencies. However, the health complications that can result due to potential side-effects from a cocktail of supplements–makes it necessary for increased consumer awareness. People should consult their physicians before taking anything.”

Supplements such as probiotics, dietary enzymes, fish oils, as well as vitamins from food sources work well when supplemented alongside a healthy diet and exercise. A conscious approach to eating habits with the knowledge of the difference in natural and synthetic supplements is the best path to health; there are no shortcuts. It would be a good idea, then, to stop listening to the hype put forth by pharmaceutical companies to increase their market share. And it might be time to stop looking to the FDA to properly regulate what we Americans consume.

Arpit Mehta is a graphic designer and photographer based in California with an interest in politics and entrepreneurship. He hopes to be directly involved in the political system one day.