Walk through the supplement section of your local health food store, supermarket, or drugstore, and you’ll see many supplements that don’t fit the category of either vitamins and minerals or herbal supplements. You’ll see strange names like phosphatidylserine and chondroitin sulfate, mysterious abbreviations like DHEA, or headline-grabbing labels like melatonin and shark cartilage. How do we classify these other supplements that are neither vitamins, minerals, nor herbs?
There are so many different kinds that they defy a single classification. Since all of them are in some stage of being tested, challenged, advertised, and marketed, however, it seems simplest to call them emerging supplements.
Many of the emerging supplements are almost literally new inventions. True, they may come from natural sources (shark cartilage is an obvious example) and be considered nonpharmaceuticals, but many of them are put together in laboratories. Before long, supplements that begin to show promise can fall into the hands of promoters who ascribe almost-miraculous powers and properties to the newly created compounds. While that doesn’t necessarily mean that they’re ineffective or even marginally unsafe, it does mean that you, the buyer, might need to beware of premature or exaggerated claims made by overzealous marketers.
Why are we so willing to try these emerging supplements, or any supplements, for that matter?
One reason is our growing desire to act preventively and steer our own health destinies, says Mark Stengler, N.D., a naturopathic doctor and author of The Natural Physician: Your Health Guide for Common Ailments. "People are taking more control over their own health, and supplements are a way of becoming proactive," he explains.
The Roads to Discovery
Sometimes, the discovery of a supplement begins with simple observation and a powerful sense of curiosity. In other cases, a new supplement is found when scientists look closely at existing data. Something as insignificant as pineapple juice is thought to be a digestive aid or the shell of a crab is suspected of being a possible arthritis cure.
There are many ways that supplements are discovered. Modern researchers may take clues from ancient medical texts or modern-day folk medicine. They may accidentally stumble across the next big supplement or test a hypothesis based on years of research.
Consider the strange case of fish oil.
Doctors working in the Arctic in the 1970s observed that the Eskimo people were rarely afflicted with heart disease, despite a high-fat, high-cholesterol diet of whale meat, seal meat, and fish.
Later, researchers in Japan in the early 1980s also noted a low death rate from heart disease in their country. Like the Eskimos, the Japanese people ate a lot of fish. Scientists began to wonder if fish was the common bond.
On closer examination of statistics, researchers found that this theory seemed to be reinforced. In Japan, the lowest death rates from heart disease were found on the island of Okinawa, where fish consumption was about twice as high as in mainland Japan. Another study compared a fishing village where residents ate as much as 250 grams of fish a day with a farming area where people ate about 90 grams of fish daily. Sure enough, the lower incidence of heart disease was in the fishing village.
These early observations led researchers to study whether some aspect of seafood was protective against heart disease. Much of the research zeroed in on omega-3 polyunsaturated fatty acids, which were found in fish oils.
Today, research points to the conclusion that the omega-3’s in fish oil reduce the risk of heart disease by influencing blood clotting and blood pressure. They may also reduce the risk of irregular heartbeat. Beyond heart health, researchers are now considering how fish oil can help other conditions, including rheumatoid arthritis and other inflammatory diseases.
Given these promising findings, it was almost inevitable that supplement makers would begin to manufacture fish-oil supplements. In fact, if you check the shelves of almost any drugstore or health food store, you’re likely to find a number of different brands and concentrations.
Gaining Respect
Nearly every week, it seems, we read about an emerging supplement that’s going to reverse aging, help us sleep better, improve our sex lives, or boost our immune systems.
How does a supplement move from obscurity to acceptability?
The media is instrumental in fueling our interest in dietary supplements, says Stephen DeFelice, M.D., founder and chairman of the nonprofit Foundation for Innovation in Medicine in Cranford, New Jersey. It was Dr. DeFelice, in fact, who coined the term nutraceutical to describe food or dietary supplements that offer health benefits, including disease prevention and treatment.
According to Dr. DeFelice, our current appetite for supplements can be traced back to the 1980s, when the word began to spread—from researchers to physicians to reporters to consumers—that calcium helps to prevent osteoporosis. The sales of calcium supplements took off, opening the door for the increased popularity of other supplements like fiber and fish oil, says Dr. DeFelice.
What set calcium apart was solid clinical data, reviewed by medical experts and published in a medical journal, says Dr. DeFelice. During a clinical trial, researchers compare health outcomes of two separate groups of people who are randomly selected. One group receives a real supplement; the other gets a look-alike pill, or placebo, that has no active ingredients. Since no one knows whether they’re getting the real treatment, any difference in health effects is more likely due to the pill than to attitudes about the pill. This is the simplest way to eliminate what researchers call the placebo effect, which occurs when people feel better because they think they’re supposed to feel better.
Prior to publication of glowing reports about calcium, most nutritional research was in the form of epidemiological studies. In these studies of large groups of people, scientists are simply observers. Rather than setting up a controlled situation, they observe what kinds of foods a group of people eat and then assess how healthy those people are.
A third kind of nutritional research uses animals, or it’s done in a laboratory using test tubes. Doctors far prefer clinical data to animal studies, lab studies, or epidemiological studies, though, because clinical data can demonstrate direct cause and effect, says Dr. DeFelice. "That’s what doctors want to know: Has this particular product been evaluated? If so, they’ll recommend it."
| Man’s Search for Power Surges As one of the greatest home-run hitters ever to step up to the plate, the legendary Babe Ruth sent 714 balls over the fence and into the pages of history. Impressive, yes. But imagine how many home runs he might have hit if only he had known about the supplement called creatine. By the late 1990s, this popular dietary supplement was being used by untold numbers of amateur and professional athletes. Whether they intended to or not, some of these athletes became, in effect, promoters of creatine as they publicly acknowledged using it. They seemed to provide living proof that creatine does what it claims—increases strength and provides short-term explosive power. While using the extra boost of creatine might seem like a form of not-so-subtle cheating, athletes throughout history have sought ways to gain the competitive edge. Our early ancestors ate deer liver and lion heart for strength and speed. Modern-day athletes and their trainers know volumes about the presumed ergogenic (performance-enhancing) effects of protein, amino acids, and common food components like caffeine. Now, creatine and a number of other so-called ergogenic supplements have joined the list. Skeptics abound. Most of the concoctions being marketed to athletes have no scientific basis whatsoever, says Melvin Williams, Ph.D., professor emeritus in the department of exercise science, physical education, and recreation at Old Dominion University in Norfolk, Virginia, and author of The Ergogenics Edge: Pushing the Limits of Sports Performance. “Athletes today are getting better because of improved training, sophisticated coaching techniques, and new technologies. With a few exceptions, including possibly creatine, I don’t really think these supplements have any impact on performance,” says Dr. Williams. Apart from the expense of some performance-enhancing supplements, there’s also the question of how much harm they might do. Few long-term studies have been done on safety, and the more widely these supplements are used, the greater the risk for a large number of athletes. Still, the market for ergogenic supplements is a billion-dollar business, Dr. Williams says. Athletes seem to be willing to try almost any new supplement, including those with known health risks. |
Based on the explosion of scientific research in the past decade, doctors are now in a better position to know what they can recommend and for what, according to Dr. Stengler.
As studies begin to prove some of the claims that are made about popular supplements, universities and companies have become less reluctant to provide funding for research in the area of natural products, adds Terry Lemerond, president of Enzymatic Therapy, a supplement company in Green Bay, Wisconsin. Also, of course, consumer demand is a stimulus to companies that can afford to perform laboratory tests. Supplements make up a lucrative market, and more companies than ever before are entering that market.
Making Pills with Possibilities
With so much interest in emerging supplements, what does it take for a new discovery to make the grade and win acceptance?
To answer that question is to tell the story of how an emerging supplement, well, emerges.
Although the process may seem mysterious, it’s actually a lot like a very big homework assignment. For instance, at Thorne Research, a supplement producer in Sandpoint, Idaho, scientists in the technical division regularly scour existing research for anything that looks promising. In many cases, some research already exists but has gone unnoticed. Often, the researchers run across dietary supplements that have been ignored by the pharmaceutical industry or the medical profession in favor of pharmaceutical drugs that can be patented, says Al Czap, president of Thorne Research.
"In many cases, things are out there, readily available. We just have to open our eyes to look for them," Czap says. "We look at virtually every journal in the world, from biochemical to phytochemical to obscure European journals. We find many things that have been overlooked or that show potential."
Just because a dietary supplement is new to researchers in the United States doesn’t mean that it’s been ignored worldwide. In some cases, a supplement is already being used in another country as an alternative to costly prescription medications, Czap says. Doctors here have little incentive to seek out alternative remedies because insurance usually covers the cost of prescription medications for their patients, he adds.
| What Gives a New Supplement a Good Name Often, the evidence and advocacy for a newly discovered supplement come from real-life stories of people who took it with phenomenal results. While such stories—what researchers call anecdotal evidence—can’t be written off as fiction, they are not accepted as proof, either. After all, what helps one person may not help another. No matter how much proof we may demand, anecdotal evidence is still compelling. Such is the case with Betty Dwyer, a woman who believes that her life was saved by a little-known supplement with an unusual name. Her doctor, too, is convinced. Dwyer, of Dallas, and her doctor, Peter Langsjoen, M.D., agree that without coenzyme Q10 (also known as coQ10), Dwyer’s condition probably would have been fatal. CoQ10 is a naturally occurring compound that our cells need to produce energy. It’s found in all cells but is most highly concentrated in heart muscle cells because they use the greatest amount of energy. Dr. Langsjoen, a cardiologist in Tyler, Texas, believes that when taken as a supplement, coQ10 protects the heart, normalizes blood pressure, and strengthens the immune system, among other benefits. In 1981, when Dwyer was 50 years old, she was diagnosed with dilated cardiomyopathy, a life-threatening condition in which the heart becomes enlarged and weak. Dwyer had asthma, and when she went to the hospital complaining of shortness of breath, she thought her respiratory problem was out of control. Subsequent tests revealed the cardiomyopathy. “My heart was increasing in size and wasn’t able to do its job. The bigger it got, the less efficient it was,” says Dwyer. “When I first went to the hospital, I was told that I could expect to live five to seven years.” At that time, doctors also told her that she’d probably need a heart transplant. After two weeks in the hospital, Dwyer returned home for some rest and recovery, but she barely improved. She was short of breath and unable to stay on her feet for very long, and she had “absolutely no energy,” she recalls. Her condition remained poor for about three years. Then she joined a research program that was using coQ10 to treat cardiomyopathy. “I didn’t have anything to lose,” Dwyer says. In 1984, she began taking supplemental coQ10 under her doctor’s supervision. Although previously she had taken a number of medications for her asthma and heart conditions, Dwyer was able to cut back to a single prescription drug that controls her heart rhythm. With that drug and coQ10, she no longer considers her diagnosis of cardiomyopathy a death sentence. “I still have the heart I was born with. And as long as it works as well as it works now, I’m going to leave it alone,” says Dwyer. Dr. Langsjoen, who has been Dwyer’s doctor since 1992, agrees that were it not for coQ10, she would have had to have a heart transplant. He also believes that she wouldn’t be alive today without this supplement. |
Once the company has decided to manufacture a supplement, Czap says, the supplements are thoroughly tested to make sure that they contain the right mixture of ingredients and are free of contamination. Samples are run through a laboratory, where an analysis is done to ensure that the product is completely mixed. A state-of-the-art instrument takes an infrared "fingerprint" of a product sample, which is then compared with the verified standard for the product and compared by computer with the other batch samples to ensure complete mixing.
The next step is to get uniform amounts of the mixture into capsules, which are made from gelatin. To make sure that all of the capsules contain the right amount of materials, samples are taken randomly and weighed. If necessary, the capsuling machine is adjusted to make sure that each capsule falls within an acceptable weight range.
Your Selection Process
Given all of the companies offering supplements, how do you know which ones are most reliable? How can you be reasonably sure that the product you buy contains what it says it does?
"In general, I educate my patients to buy brands recommended by a trusted professional, either a nutritionally trained doctor or health food store owner or employees with training and a good reputation in the community," says Emily Kane, N.D., a naturopathic doctor in Juneau, Alaska, and senior editor of the Journal of Naturopathic Medicine.
For what she calls designer supplements, Dr. Kane recommends products from Thorne Research, Scientific Botanicals, PhytoPharmica, Eclectic, Naturopathic Formulations, and Tyler Encapsulations. Some of these companies sell to consumers, but products from others, such as Thorne, are available only through a physician.
Dr. Stengler offers the following tips for selecting a supplement.
Read the label. Look for any potentially allergenic substances such as Red Dye #4. If the product does not clearly state ingredients and their amounts, do not buy it.
Ask for proof. The supplement company should be able to provide you with a product analysis of potency and purity. That analysis gives you some assurance that the product you choose is free of contaminants such as bacteria, pesticides, and heavy metals.
Choose a reputable company. Get as much background as you can on the company you’re buying from. Consider their number of years of experience in the industry and the quality of their educational materials. The company should also be able to tell you where the raw materials for their products come from, such as organic herb farms. Other measurements are the quality of their product analysis and their commitment to research and scientific validation. Finally, you should also seek out companies that have strong medical advisory boards.
Visit your health food store. In general, supplements sold at health food stores tend to be of higher quality than those sold in grocery and chain stores.
Find a direct source. Shop for a company that manufactures its own products. There is better quality control and more responsibility to the product from such companies, says Czap.
Besides being knowledgeable about labels and manufacturers, of course, you need information about the newest supplements and the claims that have been made for them. In part 2, you’ll find many emerging supplements along with the vitamins, minerals, and herbs that experts describe.
