“Today we have 260 million guinea pigs for the dietary supplement industry.” — William T. Jarvis, PhD.
William T. Jarvis, PhD, is a retired public health and preventive medicine professor at Loma Linda University School of Medicine in California and president of the National Council Against Health Care Fraud. He has been an outspoken critic of the nutritional supplement industry for decades. In his 1998 article, “Both Buyers and Sellers Should Be Wary of Multilevel Marketing” Jarvis lists these general “buyer beware” guidelines for independent distributors of vitamin supplements, weight-loss formulas, fiber-containing snacks and/or herbal remedies:1
- Products of this type are often highly overpriced.
- Exaggerated claims are often used to justify the extraordinary prices for products containing inexpensive ingredients.
- Herbal supplements may contain potent drugs that are neither manufactured nor labeled to standards used by the pharmaceutical industry.
- Peddlers of these products may misrepresent themselves as “health counselors,” when in truth they are salespeople with little to no medical training.
- Heroic anecdotes of product benefits are promulgated through visually pleasing brochures with little scientific backing or support.
Certainly during his long career, Jarvis has served as a vocal thorn in the supplement industry’s backside. Why am I telling you all this?
I was confronted with the marketing of nutritional supplements unexpectedly during my deployment to Afghanistan in 2009. Like many of my fellow soldiers, I enjoyed the occasional visit to the Army and Air Force Exchange Service (AAFES) stores. The AAFES folks are incredible in that they follow the military all over the world and provide needed consumables for servicemembers far from home.
My deployment was with the British, and their version of AAFES just did not provide the “American consumer experience” for which I longed. Because of this, we “Yanks” would trek over to a nearby U.S. Marine base to visit “the real deal.” At the time, this particular AAFES was little more than a large tent with two rows of shelves and a cash register. To this day, I am amazed at the variety and quality of toiletries, music, electronics, clothing and junk food that AAFES folks can stuff in a tent in the middle of nowhere. I was somewhat shocked and concerned, though, to observe that 25% of the shelf space in this oasis of Americana was devoted to the sale of nutritional and body-building supplements. There were huge boxes and jars of “nutritional stuff” covered in glossy pictures of “Mini-Me” sized Arnold Schwarzenegger “wannabes.” The shocking part was the price tag of all these items — just slightly less than the electronics that were available on the next shelf.
Fortunately, U.S. Medicine is kind enough to only display the picture of my face every month in this column, so readers are not visually burdened with my “body by Budweiser.” I do my share of exercise for the Army and the taxpayers, but I am not a body-building aficionado. In short, you will not find my picture on one of the jars of nutritional supplements. I, therefore, will not comment on the benefit of these products to body-building enthusiasts. I would imagine these products are desirable and in demand, otherwise AAFES would not bother to retail them on the other side of the planet in the middle of a desert.
While waiting in line to purchase some shaving cream, I scanned some of the labels of the various powders and potions available. I found lots of proteins and lists of chemicals, some of which I recognized, although many were a mystery. As a physician, I recall expressing my concern to a friend about the impact that multiple dietary protein supplementation would have on the kidneys of soldiers who were often dehydrated, exposed to intense physical activity and in a hot desert environment. I also was distressed that so much space was devoted to these expensive products, which are not subject to the same protections afforded pharmaceuticals that require testing and approval through the Food and Drug Administration (FDA).
I was reminded recently of this issue again by a New York Times article, “Army Studies Workout Supplements after Deaths” (Feb. 3, 2011). The dietary supplements, Jack3d and OxyElite Pro, were removed from all AFFES stores after two soldiers died from heart attacks that were linked to an ingredient in both products, 1,3-dimethylamylamine (DMAA). In fact, all products containing DMAA have been removed from military base retail shops, although these products remain available in civilian stores. The Army maintains that DMAA was identified in the toxicology reports of both soldiers and further noted that other reports have linked the stimulant DMAA to incidents of kidney failure, seizures, loss of consciousness and tachycardia in soldiers using supplements.
I applaud the Army’s actions in this case and believe considerably more scrutiny and control is warranted by the FDA of the supplement industry. Federal medicine has a responsibility to the patients and families we serve that the products sold on our posts and bases are safe for consumption. Our patients — Jarvis’ proverbial guinea pigs — are certainly making that assumption when they see the products on the AAFES shelves. At the very least, we should be prepared with an intelligent and knowledgeable answer when our patients inquire about the safety and benefits of dietary supplements. This month, U.S. Medicine explores the difficult issues surrounding dietary supplements and their use by our patients, important information for any healthcare provider. Based on my own experiences, I am pleased that this issue is getting the attention within our community that it deserves.