Clinic at the Health Food Store? Employee Recommendations and Product Analysis

James K. Glisson, M.D., Pharm.D., Holly E. Rogers, Pharm.D., Ehab A. Abourashed, Ph.D., Richard Ogletree, Pharm.D., Charles D. Hufford, Ph.D., Ikhlas Khan, Ph.D.


Pharmacotherapy. 2003;23(1) 

In This Article

Abstract and Introduction

Study Objectives: To determine what products health food store employees recommend for depression, to analyze the content of these products based on label claims, and to evaluate employee statements or recommendations for accuracy and safety.
Methods: Twelve health food stores were selected for the study. One investigator approached an employee in each store and asked what they recommended for depression plus five additional questions regarding product use. Thirteen products containing St. John's wort were purchased and analyzed for hypericin and pseudohypericin content using high-performance liquid chromatography (HPLC). Total hypericin content was calculated by adding the values for hypericin and pseudohypericin.
Results: All 12 health food store employees recommended a St. John's wort supplement for treatment of depression. Furthermore, numerous comments made by employees regarding St. John's wort and the treatment of depression were unsafe and inaccurate. The HPLC analysis revealed that no product contained ± 10% of the stated label claim for hypericin content, and two products contained 0% hypericin. The total hypericin content (hypericin plus pseudohypericin) of only two products was within ± 10% of the label claim for hypericin.
Conclusions: Health food store employees offer health care advice regarding treatment of depression with dietary supplements without proper scientific and medical training. Their comments could cause significant harm to customers. In addition, the inconsistencies of dietary supplement content continue to raise concern for individuals who use these agents as medical treatment.

Over the past decade, the use of dietary supplements by the general public has escalated dramatically.[1,2,3] Patients with chronic conditions such as depression may even take these supplements in addition to or as a substitute for conventional therapies. However, the mainstream medical community has been less enthusiastic about embracing alternative therapies. Physicians express concern regarding the composition, safety, and efficacy of these supplements. Health care providers are apprehensive about the scientific validity of claims made by manufacturers and promoters of these supplements.[4,5,6,7]

Significant concerns have been voiced in the medical literature regarding inconsistencies with product ingredients, such as contaminants, as well as possible supplement-drug interactions.[8,9,10,11,12,13,14] Health care providers worry that patients with serious medical conditions may postpone or avoid seeking advice from a physician in favor of self-treatment with a dietary supplement.[15] Furthermore, these products often are marketed as natural alternatives to synthetic prescription drugs, thus making them allegedly void of adverse effects.

Consumers often consider these supplements safe because they are natural. However, safety data for these products are usually scant. The general public supports government regulation concerning safety and purity of dietary supplements.[8,16,17,18,19,20,21] Nevertheless, the public is not willing to relinquish the freedom of purchasing these products despite the lack of adequate data regarding their safety, efficacy, and quality.[16] Ultimately, patients would prefer to discuss these therapies with their physicians, but hesitation is the rule and not the exception.[20] They may rely on other sources, such as the Internet, friends, or health food store employees, for information about these so-called natural therapies.[3,19,20,21,22,23] Furthermore, patients may receive medical advice from employees at health food stores who do not have the appropriate scientific and medical training.

Finally, whereas reports of health food store recommendations have been published in the medical literature, our investigation included an additional variant.[24,25] We not only recorded the employee comments but also purchased the recommended products for content analysis by high-performance liquid chromatography (HPLC). The results of this study and the potential impact on the dietary supplement industry are of considerable interest to consumer advocacy organizations, the medical community, and other parties.

This self-funded study was conducted to determine what products are being recommended and to present some of the information disseminated by health food store employees regarding the treatment of depression.


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