Wednesday, February 26, 2014

Is Faith In Dietary Supplements A New Religion?


In 2012, the Pew Forum of Religion and Public Life published survey results that concluded that "the number of Americans who do not identify with any religion continues to grow at a rapid pace. One-fifth of the U.S. public – and a third of adults under 30 – are religiously unaffiliated today, the highest percentages ever in Pew Research Center polling. In the last five years alone, the unaffiliated have increased from just over 15% to just under 20% of all U.S. adults." Around the same time, the Centers for Disease Control and Prevention (CDC) reported that dietary supplement use had markedly increased with more than one half of the U.S. population currently taking some form of dietary supplement.

What's going on? Is there any relationship between Americans' growing dissociation with religion and their expanding use of dietary supplements? I think so. It appears they are trading one belief system for another.

I proffer that there is a new religion in America and it is called Supplementiasm, which is an unwavering belief in the health benefits of consuming dietary supplements.  I believe that Supplementiasm is the fastest growing U.S. religion based on the CDC's estimates plus dietary supplement industry reports that now claim as high as 80% of all Americans are users—a number that has grown some twenty-fold in the past 15+ years alone.

Like other religions, Supplementiasm has both steadfast disciples who vigorously defend its tenets and vehement detractors who question its legitimacy.  It's more extreme disciples will ridicule and attack anyone who challenges its omnipotence and veracity.  When three studies published a few months back in The Annals of Internal Medicine concluded that "limited evidence supports any benefit from vitamin and mineral supplementation for the prevention of cancer or cardiovascular disease," including an editorial titled, Enough Is Enough: Stop Wasting Money on Vitamin and Mineral Supplements, the faithful of Supplementiasm took the offensive.

Not surprisingly, Steve Mister, President of the Council for Responsible Nutrition, the main trade association for the dietary supplement industry, went on record by stating that "we reviewed the literature and came to the opposite decision" as his organization found the same studies showing that multivitamins now "had the potential for additional benefits." That response was mild when compared to other pro-supplement pundits that labeled the Annals' conclusions "bunk right off the bat," "garbage in garbage out" and "highly premature and unscientific." The rhetoric on the internet got so heated that it nearly dared comparison to the controversy surrounding the cartoon depictions of Islam's revered founder several years back.  Challenges to faith always stir emotions.

As with most of the major religions, Supplementiasm offers its devout many places of worship from small health food storefronts on the internet to corporate retail megastores and many venues in between. Supplementiasm also has it religious leaders like Doctors Mehmet Oz and Andrew Weil, who spread its gospel with almost missionary zeal. In response to the Annals controversy, the Dr. Oz Show devoted two segments during different episodes to reaffirming Oz's personal faith in multivitamins, going so far as to declare that he and other members of his family take them at home. Of course, with Walgreen's Pharmacies, significant sellers of dietary supplements, and Schiff Vitamins, manufacturers of the same, listed as "Trusted Partners" on his show, it was not surprising that Oz came to their defense. In fact, many in the supplement industry credit Oz's regular pro-supplement pronouncements as the basis for their growing popularity.

Another common factor among major religions is the splintering of groups. For example, Christians, have Catholics, Baptists, Protestants, etc. Jews have Orthodox, Conservative, Reform, etc. and Muslims, have Sunnis and Shiites.  Similarly with Supplementiasm, one can find segmentation among the highest devotees to dietary supplements, with membership in various sects such as Vegans, Vegetarians, Juicers, Calorie Restrictors, Anti-Agers, etc.

While Supplementiasm may have fervent followers, I do not count myself among them. In fact, you could label my beliefs as agnostic, as I am full of doubts and questions.  You see I've been down this path before. I was raised in a religious household, was schooled through college in religion-based institutions, and grew up with the expectation that I would take the leap of faith in embracing my religion's core belief system; I understand what it means to make religion part of one's life; I also appreciate that the absence of or ability to appreciate the available evidence that supports religious belief does not always represent evidence of absence.  In other words, I may not be able to prove there is a G-d, but I can still put my full faith in one. 

In addition, my mother was an early devotee of dietary supplements as she zealously read Prevention Magazine as early as the 1960s. Based on her early readings, she had me eating calf liver as often as I can remember to ensure an adequate iron supply.  Every breakfast throughout elementary school consisted of a mixed bowl of cottage cheese (my daily needs), fresh squeezed orange juice (my vitamin C), fresh ground apple sauce (other vitamins and nutrients), and wheat germ (the B vitamins). By the way, yes, it tasted like you think.  Nevertheless, it was served and eaten religiously every day. For lunch, to make sure I got enough protein, my mom would wake early to make fresh fried chicken cutlets.  (I must admit I appreciated her daily effort and they tasted quite good, unlike the breakfast bowl.)

For a number of years, my mother-imposed imposed routine also included daily spoonfuls of cod liver oil (my omega-3s). In later years, her preaching included carrots for beta-carotene, and multivitamins and fish oil pills. Even in my 40s, she was pounding the pulpit in favor of supplementing with folate, a B vitamin.  Don't get me wrong. My mother is a smart lady who wanted what was best for her family. But her reacting to the latest "science" was misguided—a lesson she eventually learned on her own.  I also don't think that Prevention Magazine meant any harm. It was only reporting on the latest studies. I'm not sure my mother could have ever imagined how fast such beliefs would eventually spread and how much of it was plain wrong and potentially harmful, with calf-liver being a prime example (now thought to contain too much iron for men and too much saturated fat for others). My mother, a religious woman also by upbringing, just wanted to do right by her family.  As she already believed in one faith based system, it wasn’t much of a stretch to believe in another.

So given my religious proclivities, one might think that I would have a penchant for Supplementiasm. Well, I did until about three years ago. In 2011, I opened a primary care and preventive medicine practice and one of my first actions was to purchase five thousand dollars’ worth of dietary supplements for sale to patients. My initial list of dozens of products was whittled down to about thirty products, including calcium, Vitamin D, melatonin, fish oil, alpha-lipoic acid, etc. as initial research indicated they were the most reliable products to offer. Then I started intensively reading the scientific literature by securing a paid subscription to the Natural Standard database of dietary supplements and herbs and reviewing the clinical literature on my own, and as I read more, the more my faith waned. I developed a decided bias against the bulk of dietary supplements.

After reading over 40,000 studies and abstracts found on the government's website of published clinical literature called Pubmed and other online databases, one thing was clear. Dietary supplements were not the panacea their manufacturers claimed they were. In many cases, they were a waste of money, and at times even posed a real harm.  Based on my collected data, I developed a lecture titled Why Dietary Supplements Are Usually a Waste of Money and May Be Harmful that was delivered dozens of times to thousands of people across Southeast Florida, including through TV and radio appearances.  At some of these forums, the Supplementiasm adherents pushed back--the old adage of not discussing religion and politics with strangers proved true.  Sometimes it felt as if I was insulting their G-d, while all I was asking for was the evidence upon which they were relying.  Some of these pill-pushing disciples included licensed and practicing physicians hawking unproven, often very expensive products.  My words often made no impact as far as I could tell and when they were pressed to produce their holy scripture upon which they relied, they often stumbled and fumbled in their failure to produce anything resembling good science.

So at this point, you may think me atheistic about Supplementiasm, but that would not be true. The search for the truth and to try and differentiate between the science and pseudo-science continues. I am not prepared to reject dietary supplements completely out of hand (as I do believe in certain supplements like Vitamin D and calcium in certain cases; though, I always prefer food over pills for nutrition) but my concerns are many and growing (particularly as the industry also continues to expand rapidly). Based on my accumulated knowledge, I feel very few Americans should be taking any dietary supplements without physician guidance, including multivitamins, and most clinical thought leaders, in the dietetics and medical fields agree with me.

However, like any true theologians, the disciples of Supplēmentiasm hold steadfast in their beliefs and cannot be easily dissuaded.  An anecdote bears proof. The supplements mentioned earlier that were purchased for my practice came from a company I came across at a medical conference that seemed reputable. When I decided to no longer include supplements in the practice, it meant no further purchases from the company and this displeased the sales representative.  In response, the representative asked if the company could check my blood to see if I have any vitamin deficiencies because they are sure everyone does.  Wow, I thought.  The representative had really drunk the Kool-Aid. By the way, my blood tests were normal.  Another company had me test my antioxidant levels on their patented scanner, which many revere as one of the sacraments of Supplēmentiasm. The scanner scored me in the highest echelons of carotenoids, an antioxidant whose measured levels are thought to be indicative of total antioxidant activity in the human body.  I scored extremely high despite my lack of supplementation; rather, I imagine, because I eat several servings of fruits and vegetables every day. It was a waste of a test. But that's not even what disturbed me. The representatives, when confronted with the results, always argue that I am the exception.

An even bigger concern is the degree of sacrosanct belief that so many, sellers and consumers of such products (I suspect she's a user), harbor about supplementation. For millions of years, men and women and their predecessors lived off the land and somehow that no long suffices. The supplement marketers propagate stories about soil depletion creating nutrient poor fruits and vegetables. My review of over a 100 studies of nutrient depleted soil showed that in 100% of the cases, the produce failed to grow properly and were not edible. Yes, soil may be depleted, but the studies show that fruits and vegetables that actually grow and make it to our hands still have plenty of nutrition.

Furthermore, despite the fact that not a single valid human study has ever demonstrated an extension of a single day of human life from supplementation in the absence of deficiency, nearly $30 billion was spent last year on these products. My own experience with attempts to talk some patients off of taking supplements got the nastiest looks imaginable. Sometimes successful, some patients would return to tell me how much better they felt having stopped the pills. My response was that what they were experiencing was a placebo effect because the supplements had no effect on them while they were taking them.  For those who wouldn’t stop, it was clear that they were believers that their products were sacrosanct. They believe despite the absence of any tangible evidence; their beliefs are as strong as any religious faith.

However, my greatest concern is that this growing dependence on dietary supplements increasingly may strip people of any responsibility for their lifestyle choices. Pop a pill or two or twenty and you are all set. Nothing to worry about. This is a very dangerous thought process.  The same can be said for prescription pills.  Most prescription pills treat symptoms, not the underlying disease. There are far too many prescriptions written unnecessarily in this country. Proponents of supplements often point to the fact that prescriptions kill over 100,000 per year while there are no harms associated with supplements. The facts are that the 100,000 was an estimated and extrapolated number that appeared in one paper that also described that most of the deaths were attributable to oxycodone overdoses.  There have been numerous reports of health issues caused by supplements and many issues probably go unreported because patients often fail to tell their physicians and physicians often fail to ask if patients are taking such pills.

I am respectful of all religions. However, I must confess that I wish this Supplēmentiasm, with over 55,000 products now on sale, would be exposed for the chicanery that it mostly represents. While there are many wonderful attributes to religion, and to religious belief and practice, the facts remain that religious extremists have been responsible for many destructive and irresponsible actions over the centuries. Let's hope that Supplēmentiasm's leaders do not yet prove to do the most harm.

As to the supplements I bought for my practice, I gave a few for free to a handful of patients that I thought would benefit, gave the more scientifically supported pills to a nearby homeless shelter, and discarded the rest. I had learned an expensive lesson, but my religious sensibilities to do the right thing were well served. I pray that one day the disciples of Supplementiasm will come to the same conclusion, but I have little faith that day will come soon.

This parody is not meant to insult any religion or any person of religious faith. It is provided for thought and discussion purposes only.

6 comments:

  1. Unlike religions I do not try to "convert" others to using vitamins and supplements. I k\now from 40 years of use that they have helped me as much as or more than medications. I just want you and the FDA to let me alone and stop trying to take my freedom to buy them from me. In return you can continue to poison your patients with FDA approved "medicine".

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  2. Whoa, where's this negativity coming from? This piece is a parody of how some people have such strong faith in supplements that it almost equals a religious belief.

    Why would you write "poison my patients?" If you read the bulk of my blogs, you would know that I never advocate pharmaceuticals to patients when better alternatives are available, and that they should only be used as needed in a prudent and judicious manner. Nor do I advocate the use of nutraceuticals in the absence of valid evidence of their efficacy and safety.

    That said, I am curious which vitamins and supplements you feel have helped you over 40 years? How have they helped you? Why did you need help? When did you start needing this help?

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  3. As one former yeshiva bochur to another, let me say that we are inclined to metaphors using religion that can be jarring to people who have thought less about the subject than we have. The effort to move people from their vitamins and other false nostrums is laudable, particularly as it is done without financial motive. Why take on a second fight? In any case I loved your lecture today.

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  4. Thank you. I've taken on this challenge because too many people are lulled into a false sense of security by taking such pills and I want them to have at least a modicum of balance in understanding the alternative perspective.

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  5. I was thinking a lot regarding this topic, so thanks for bringing it up here. You certainly have a good writing style i like, so will be subscribing to your blog.
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