Bad Medicine

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So does that mean I’m already dead? Because I can’t eat a lot of the foods that naturally contain a lot of important vitamins. Like vitamin c which comes from fruits and certain organ meats. And I can’t rely on a lot of the foods that are fortified with them, because they’re fortified with the wrong forms. Like thiamin mononitrate, which triggers my migraines.

P.S. And correlation is not causation. People may be taking these supplements because of health issues, whether it’s because they can’t eat certain foods, or because they’re very sick and not getting treatment and trying to find accessible and/or affordable options.

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22

Well, yes, that’s true. In fact, supplement use is correlated with better health. The study was trying to take care to tease out the effects of supplements, both as a whole and individually, by controlling for other health-related factors:

At first glance, those taking supplements seemed to fare well—showing a reduced risk of all-cause mortality during the survey. But that association vanished when the researchers considered demographic and health data. “Our results and those of others suggest that supplement users have higher levels of education and income and a healthier lifestyle overall (for example, better diet, higher levels of physical activity, no smoking or alcohol intake, and healthy weight) than nonusers,” they wrote. Thus, “the apparent association between supplement use and lower mortality may reflect confounding by higher socioeconomic status and healthy lifestyle factors that are known to reduce mortality.”

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23

That article made it sound like an incredibly vague, too-large study.

I used to eat a couple of packages of baby spinach a week and two cups of almonds a day – not exactly healthy from a calorie intake point of view. Turns out I was deficient in magnesium. Figured it out with some help when my muscles started spasming.

It took two weeks for the supplements to kick in.

Anecdote not data, blah blah blah, but I couldn’t help but notice the article failed to mention of the people taking the supplements were actually deficient in anything, or if they had difficulty absorbing certain nutrients (B12 is another one for me).

Yes overall diet is important – which is why models and actresses infamously need to watch their fat intake, because if it goes too low they are at risk of not being able to absorb vitamins E and A – but it falls to address how a lot of us wind up on supplements in the first place: because we’re eating the prescribed foods and winding up deficient anyhow.

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24

My vitamin D was low, probably due to low rate of absorption due to crohn’s, so I started taking supplements. The level went up. Makes sense.

But if you’re getting enough through food, then supplements won’t do a darn thing, and may cause problems – too much calcium can lead to calcification of blood vessel plaque and blood clots, strokes, heart attacks and so on.

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25

I think that was the point they were trying to make, along with the fact that if, as an example, your calcium intake goes through the roof due to dairy products, your body can eliminate the excess a lot easier than if it goes through the roof due to a calcium supplement, and the same seems to hold true for other supplements.

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But how are you supposed to know? Unless you have access to a doctor and approval for blood tests?

Aside from watching symptoms-- my slightly bluish sclerae and recurring folliculitis may point to some kind of anemia, or maybe not. my neurological issues, and fatigue, and post-exertional migraines, who knows.

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27

This is assuming a decent health care system that doesn’t exclude people, which we do not have.

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28

I think both of these things can be true without necessarily contradicting each other. Clearly, vitamins/micronutrients affect your health, especially if you have too much or too little of a particular one. My mother (if I may add my own anecdata point) was having issues with fatigue and energy levels and went through quite a bit of dietary experimentation and analysis until they ultimately ended up giving her a vitamin B (maybe B12?) shot, or rather, a series of such shots, and she said it was like night and day. It fixed her right up.

But most people aren’t my mother.1 And I think that was kind of the point of the study. Not that they can’t help some people, but that supplements are probably useless for most people taking them, and might even make things worse for some.

FTA:

Still, more than half of all adults in the US say they use supplements. Ten percent of us report using four or more each day.

That’s a lot of people taking something they probably don’t need, and some of them will likely be worse for the wear. And I think that’s a point worth raising.

I once heard a nutritionist describe their efficacy as something like “vitamins mostly just give you expensive pee.” The way she phrased it was funnier than that, and she was careful to qualify her skepticism, but the point was that most of whatever nutrient you get from a supplement is going to just pass right through, instead of being absorbed by the body.

That’s a good point. If you can’t get some help identifying the root of a particular complaint, I can totally sympathize with the urge to experiment with whatever potential remedies are available to you. I even get hedging your bets and taking a daily multivitamin “just because”.

But I think there’s also another form of the “how do I know?” question. At the risk of adding to your uncertainty, how do you know that the supplements you’re taking actually contain the nutrients that you think they do, in the dosages that you think you’re getting?

The OP contains a link to another Ars post, that says:

The Food and Drug Administration is not authorized to review supplements for safety and efficacy before they hit the market. That means the bottles and capsules that line the aisles of grocery stores, pharmacies, and specialty shops may not contain what they say they do. They may have wildly variable amounts of supplements in each batch. They may have hidden, illicit components like amphetamines. They may even have harmful contaminants such as lead and cadmium.

The bottom line is that these supplements could contain just about anything, and you have no practical way of knowing what’s really in them. I used to feel like I needed a tin foil hat disclaimer when I talk like this, but given the reality of our neoliberal global economy, late stage capitalism, and all that, I don’t think I actually sound all that wacky. After all, just because you’re paranoid doesn’t mean they’re not out to get you. And we’ve seen plenty of evidence that they really are out to get us (e.g. Purdue Pharma and the Sacklers).

1. which I suppose is kind of tautologically obvious, I’ll admit. :wink:

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29

Regarding a slightly different kind of supplement

This is why when people tell me I should try this super fancy herbal supplement they found I tell them that I will stick with ibuprofen for my headaches and desloritidine (Aerius) or Benadryl for my allergies. Because drugs are regulated.

I don’t care how “natural” your exotic plant extract is. Mine comes from somewhere with proper QA and has known side-effects and interactions. The LD-50 has been recorded. Sure, it’s manufactured chemical. It’s also an unadulterated (fillers, yes. Undeclared substances, no) measured and standardised dose.

Big Pharma may not be angels, but I generally trust them more than Big Supplement (and some of those are huge).

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30

Whenever someone gushes about something being all-natural, I remind them that cyanide, arsenic, and lead are all all-natural. That usually shuts them up.

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32

Hear, hear!

This is what I don’t get about the “regulations are evil” crowd. Besides being the reason corporations can’t, for example, literally poison your drinking water, they’re also almost fundamentally about having a common, objective framework for describing what constitutes a “regular” dose or serving or portion of whatever it is that’s being measured.

I’ll admit that one of my favorite things about the legal recreational cannabis markets in some states is that I have at least a fighting chance of estimating how high I’ll get when I consume edibles. :crazy_face:

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33

This is super-common among women. I’ve probably been a candidate for this one upon a time.

Like a lot of chronic things mostly women get though, it can be very difficult to get a diagnosis and treatment. Doctors get very little nutrition education, and are famously bad at identifying symptoms caused by deficiencies.

Saying “you probably don’t need supplements and if you do take them they can harm you” is one thing. Providing the infrastructure so people can get deficiencies assessed properly is something else again.

Did you know you have to be quite severely anemic before you’ll test positive for anemia? I was so anemic my period was starting to disappear, but I was told there was nothing wrong with me and I was being a hypochondriac. Then I was told to take iron supplements, when the real issue was a lack of B12 so I couldn’t absorb the iron.

How much of my chronic health issues come from being ignored and laughed at by doctors while I spent years/decades figuring it out for myself? And I’ll concede I might not have it right still, but it’s not like I’m getting any support from the medical establishment to figure it out.

“You probably don’t need those supplements” is not a root cause analysis.

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35

I already have enough allergy problems, I don’t need to take bedryl to induce more…

Either way, the patient info and the packaging for prescription drugs often fail to list inactive ingredients. I have to go home, and go online, and see what it … fuck “acacia” it probably contains gum arabic, I’m allergic to it.

This is useful: https://dailymed.nlm.nih.gov/dailymed/index.cfm

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36

Been doing some thinking, and what you’re saying is exactly why this post belongs in this thread. It’s something that seems on the surface to be common sense advice, but looking at it, that breaks down. For someone like you, it’s saying the almonds and spinach are better, even when they’re not.

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37

I do know people take supplements when they shouldn’t. A friend of mine used to date a woman in the supplements industry, and the way she passed the pills before every meal freaked him out. He asked what they were for, and of course there was no good answer.

But to me that’s kind of “well, duh”, and not looking at what people with actual deficiencies go through.

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38

Depends on which part of the crowd you’re talking about.

Current drug regulations have shut out the little guy. People who would be happy to have their herbals tested and regulated can’t find labs willing to do the tests, even when they can afford it. It’s not so much the regulations are evil as the way they’re set up is only for the large corporations.

That’s an issue across industries, not just with pharma. Basically anything that got regulated in the 1890s or later has the same problem.

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39

And why is that? Because government-run labs have been continuously underfunded and therefore can’t handle the volume they’d face, since they can’t discriminate against large or small companies. Why?

Well government labs would be taking money away from private labs – governments shouldn’t be duplicating services from the private sector, that’s anti-business! But since the private labs don’t have to provide affordable service, they can charge prices only a big company can afford.

But rather than providing services to allow all companies to comply with regulations, when enough small companies complain about the barrier, suddenly it’s “the regulations are too onerous! We must therefore relax the regulations”.

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41

God damn, the FDA was working on this problem back in early 2000’s, if I recall right. In the same building as me. Why did it take so long? (Answer: regulatory capture & congressional meddling with the medical device laws.)

ETA:

“In order for these mesh devices to stay on the market, we determined that we needed evidence that they worked better than surgery without the use of mesh to repair pelvic organ prolapse,” said Dr. Jeffrey Shuren, director of the F.D.A.’s Center for Devices and Radiological Health. “We couldn’t assure women that these devices were safe and effective long term.”

In order for them to STAY on the market? How about in order for them to be put on the market in the first place?

Oh wait, this was a 510(k) device, which means it is “substantially equivalent” to a device marketed before 1976, when the law was passed giving the FDA jurisdiction over medical devices (before then they weren’t regulated, except for radiation emitting devices). The 510(k) refers to the paragraph in the law that let manufacturers grandfather in certain lower risk devices that had already been on the market before 1976. The meshes were grandfathered in, from surgical meshes for hernias available since the 1950s.

The trouble with this model is that something can be “substantially equivalent” to a device that is “substantially equivalent” to a device “substantially equivalent” to a device that is “substantially equivalent” to a device marketed before 1976. It’s called feature creep, and the suspicion is that minor change after minor change is done deliberately by companies to avoid having a “new” product.

After over a decade of injuries to women, the FDA finally changed vaginal meshes to Class III in 2016, which requires the kind of testing a heart valve would need (in other words, a clinical trial, etc.). But a clinical trial after the fact is just ludicrous.

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42

Just spitballin’ here – so I might be jumping to conclusions – but, I’m not so certain that the target audience didn’t also play a factor. But, that’s just me.

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