Do You Believe in Magic? Topol, Offit on Alternative Medicine

; Paul A. Offit, MD

Disclosures

October 02, 2013

In This Article

Resveratrol: Looking for the Fountain of Youth

Dr. Topol: Now one thing that you didn't get into -- and this has had a much more scientific story with the study by David Sinclair and the group at Harvard[3] -- is resveratrol and its effect on antiaging. Thoughts about that one?

Dr. Offit: The antiaging industry itself is about a $6 billion-a-year industry. It is a huge industry. The notion that we can in some ways turn back the clock has been something that has been attractive to us ever since the days of Ponce de Leon. We are always looking for the fountain of youth, and we do live longer than we used to, but the reason that we live longer than we used to has everything to do with the way that we live and nothing to do with the way that we age.

We have had vaccines. We exercise more. I think we are more careful about our diet, about eating more fruits and vegetables, and trying to avoid stress. All of that has contributed to our living longer, and I think that you can take this entire antiaging industry and say that it has contributed nothing to why we live longer.

I wrote this book because there are about 54,000 dietary supplements on the market; I wanted to find things for which there was clear evidence that they were of value, and so I came up with, for example, folic acid for the pregnant woman. I think you can argue that melatonin actually is of value at some level regarding insomnia. There are even some data that St. John's wort is maybe of value for someone who is mildly depressed. The problem with the industry, though -- and this is what I had trouble getting around -- is that it is unregulated. So you may have a study that shows St. John's wort as having value in mild depression, but it is hard to compare one study with the next because the label that is on the bottle may in no way accurately reflect what is in the bottle because it is unregulated.

What's Really in the Bottle?

Dr. Topol: That is a key point. A number of years ago in The Lancet,[4] you may recall, and I think you referenced it in the book, there was a very nice randomized trial of glucosamine for knee osteoarthritis. But the problem, of course, is that the preparation that was used in the trial -- the one positive trial -- you would have a hard time finding that particular preparation and dose because, as you say, it is an unregulated industry.

I didn't know the background about how unregulated the industry is until I got into your book. I found it fascinating that this cartel of vitamin supplement companies came together in Santa Barbara and put out this big campaign with Mel Gibson [featured in commercials]. That was amazing to me. I really learned a lot about Sen Orrin Hatch (R, Utah) [and his role in the Dietary Supplement Health and Education Act of 1994 (DSHEA).[5]] Can you comment about the politics and the background that has prevented the US Food and Drug Administration (FDA) from having their rightful oversight of this humongous area of health and medicine?

Dr. Offit: It is exactly what you would think it is. Because it now is almost a $34 billion-a-year industry, there are a lot of people making a lot of money, including big pharmaceutical companies. Pfizer bought Alacer recently, which is probably the biggest maker of megavitamins in the United States. Hoffmann-La Roche has been a player in the megavitamin and supplement game since the 1930s.

People have this sort of false notion that there is big pharma on one side and then on this other side, there are just a group of people who want to make natural products, and that they are being made by elves and old hippies on mountainsides. That is not the way that it works, and not surprisingly, when you have a big industry, which at least up until the early 1970s was unregulated, initially the interest by the FDA was to regulate the megavitamin industry -- because they felt that there was no clear evidence that giving vitamins at 150% or more of the recommended daily allowance was of value, and they worried that it would be harmful. At the time, there weren't data to show that it was harmful. Now there are. Now there are more than 20 studies to show that if you take large quantities of vitamin A or vitamin E or beta-carotene, which is a vitamin A precursor, you actually increase your risk for cancer and increase your risk for heart disease.

I believe that if this were a regulated industry, there would be a black box warning on these megavitamins, and this is a problem. I will give you another example. I walked into a GNC store about a week ago and bought a vitamin E preparation that said "natural vitamin E" on the front. On the back, it said "3333% of the RDA" (recommended daily allowance). That is 33 times the recommended daily allowance.

This one capsule was about maybe half the size of an almond. Almonds are an excellent source of vitamin E. You would have to eat 1650 almonds to get what was in that 1 capsule. How is that a natural thing to do? I think if people saw this for what it was, they would be suspicious, and they should be more suspicious about what the word "natural" means.

The industry has been able to keep the FDA at bay, and I don't see this changing anytime soon. So not only do we not know what the potential harms of these products are, not only do we not know that a lot of these claims are simply false claims, but we don't even know what is really in those products. I mean, what is on that label may in no way reflect what is actually in that product.

Look at what happened with this vitamin-maker called Purity First. Purity First, a few weeks ago, had all of its products recalled by the FDA. They made 3 products. They made vitamin C. They made a multimineral preparation, and they made a B-complex vitamin preparation. What happened was there were 25 women in Connecticut who started to develop symptoms of increased hair where they didn't want hair to be, deepening of the voice, and loss of menstrual cycles because they were inadvertently taking anabolic steroids. Anabolic steroids had contaminated those preparations. How does that happen? And yet, when it was taken off the market, the CEO of that company said, you know, it is just big pharma trying to shove out the little guy.

Their vitamins were contaminated with anabolic steroids. Just imagine if vaccines were inadvertently contaminated with anabolic steroids. You would never hear the end of it, but here somehow it all gets a free pass.

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