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How Good Are Your Supplements?

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The dirty little secret is out. No one is minding the store when it comes to vitamins, minerals, herbs or dietary supplements.

Are you taking a multi-vitamin? What about specific nutrients like vitamin C, vitamin D, calcium or magnesium? Do you take herbs or supplements such as glucosamine, turmeric (curcumin) or fish oil? Do you have any idea what's in your supplement? Chances are you rely on the label, but that may be quite misleading.

Do not count on the FDA to monitor your vitamins, herbs or dietary supplements. They don't seem to have the motivation or the resources to analyze what is on drug store and health food store shelves. And many Americans would prefer that the FDA not meddle. Trouble is, burying your head in the sand and pretending everything is fine and dandy is not the answer.

Fortunately, researchers at the Kaiser Permanente Center for Health Research in Portland, Oregon did the FDA's job. The results [published in JAMA Internal Medicine, online, Feb. 11, 2013] reveal something shocking. What's in the pills often does not match what's written on the label.

Erin LeBlanc, MD, MPH, was studying the impact of vitamin D on menopausal women. She and her colleagues obtained special vitamin D3 pills from a compounding pharmacy. To be on the safe side, Dr. LeBlanc had the pills analyzed. To her dismay she stumbled across a serious complication..."we found that compounded vitamin D3 (cholecalciferol) supplements varied significantly in potency." This preliminary study uncovered amazing variability:

"Only one-third of our compounded study pills met US Pharmacopeial (USP) Convention standards, which require that compounded pills contain 90% to 110% of the active ingredient."

Instead of stopping there, this discovery led Dr. LeBlanc and her colleagues to go shopping in five Portland stores. They purchased 55 bottles of over-the-counter vitamin D3 from 12 different suppliers. Five bottles were supposed to be identical because they all had the same lot number. Five bottles had different lot numbers and doses ranged from 1,000 IU to 5,000 IU as well as 10,000 IU. In addition, these researchers obtained vitamin D from a compounding pharmacy (1000 IU and 50,000 IU). They then analyzed the potency of the various vitamin D products.

The results should send shivers up and down your spine:

"The potency of pills from different lots ranged from 9% to 140% of the stated dose."

In other words, some of the tested pills had barely any vitamin D at all while others had substantially more than promised. But here's the kicker. Dr. LeBlanc also analyzed "1 pill from each of 5 bottles with the same lot number." In theory, these vitamins where all made by the same company on the same production line at the same time (hence the same lot number). The "potency ranged from 57% to 138%." In other words, these supposedly identical pills weren't identical at all.

The specially compounded vitamin D was also way off target:

"The compounded 50, 000-IU cholecalciferol tablets contained 52% to 105% and the 1000 IU compounded tablets 23% to 146% of the expected dose. Only one-third of pills were within 10% of the expected dose, which is the USP Convention standard for compounded pills."

We don't know about you, but when we buy vitamins, supplements or over-the-counter medications we expect them to fall within the 90% to 110% limits set by the USP Convention. Actually, we expect even better. If we are going to buy 200 mg of ibuprofen, we expect that our pills will have 200 mg of ibuprofen, not 18 mg [9%] or 280 mg [140%]. Why should we put up with anything less for vitamins or supplements?

The conclusion of Dr. LeBlanc and her crew:

"The cholecalciferol [vitamin D3] content of OTC and compounded vitamins was highly variable; potency ranged from 9% to 146%. In our test, just over one-half of OTC pills and only one-third of compounded pills met USP Convention standards...Pill variability may also threaten validity of vitamin D trials that use compounded pills to blind participants. As more people take vitamin D supplements, it is critical that health care providers and patients understand that cholecalciferol potency may vary widely."

In truth, it is unlikely that such lack of quality would harm patients unless they were severely vitamin D deficient and took a product that was dramatically sub-potent. But the real concern here is that this may just be the tip of the iceberg. Clearly the FDA is NOT guarding the henhouse. No one is...not even the fox.

If Dr. LeBlanc had not done some preliminary testing that piqued her concern and curiosity, we would never know that there was such a quality control problem with vitamin D3 pills. So, what about other vitamins, minerals, herbs and dietary supplements? ConsumerLab.com tested multivitamins a few years ago and found that roughly a third of the analyzed products were either contaminated or had substantially more or less than the labeled dose of ingredients.

So, is your fish oil fishy? What about other supplements? Once we open this door, we have to ask about over-the-counter medications? If the FDA is not testing products off the shelf the way Dr. LeBlanc did, how can we be assured that they contain what they claim or don't contain some contaminant that should not be there?

Here is the other dirty little secret. The FDA is NOT routinely checking on much of anything. The feds do NOT randomly buy medications off pharmacy shelves (OTC or prescription) and test for quality. What that means is that consumers are pretty much on their own whether it is a vitamin, an herb, a supplement or a drug. ConsumerLab.com does test a variety of vitamins and supplements. You can access their full reports for a price ($33 for a year's subscription). They analyzed calcium supplements (including vitamin D, vitamin K and magnesium). Several failed to meet quality standards. ConsumerLab also recently tested 35 fish oil products for quality. Roughly one third (11 out of 35) failed the tests.

BOTTOM LINE:

Based on Dr. LeBlanc's study in JAMA Internal Medicine, we have a problem. Without someone minding the store, we cannot trust our vitamins, minerals, herbs or other dietary supplements. Unlike other countries where there is close federal oversight (Australia is WAY ahead of us in this regard), Americans are pretty much on their own.

Should you wish to learn more about vitamin D3 in general, you may find our Guide to Vitamin D Deficiency of value. We would recommend that you get your vitamin D naturally, by spending some time outside in the sun with your skin exposed. At this time of year, though, that may not be practical if you are in an area where the temperature is freezing and the sky constantly overcast. The guide will tell you about the right tests to ask for, how to interpret the numbers from the lab and the amount of vitamin D3 you should be taking if you could trust the label.

We would also like to hear your story about vitamins, minerals, herbs, dietary supplements and medications (OTC as well as prescription). Have you ever had a problem with quality control? How did you determine that there was a problem? Please comment below.

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33 Comments

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My vitamin d level was in the 302 range and I would take 100 mg vitamin d periodically and last year my level dropped to 25. I now take 2000 u almost daily. I live in a warm climate almost all year and have much light exposure. I also have NO health issues but will be interested to see what my level is next month when I have blood work done.

Based upon the information contained in the study and in your article, should anyone even bother taking vitamins and supplements? What is your opinion on this? What is the benefit of taking something whose ingredients I can't be sure of versus not taking them at all? (for example, a multivitamin, calcium, fish oil, etc.)

How do we, that take vitamins, especially D, Calcium, Multi,B12, Magnesium, probiotics, etc. know which ones to buy. Is there a book, paperwork one can get to identify the vitamins that have the best helpful ingredients we need, especially in the Winter months? Thanks for writing about this as I spend a lot of money a year for vitamins to try and stay healthy. Where are the best sources in food for Vit. D, Calcium in vegetables to eat to provide enough of these vitamins. Thanks for a great newsletter.

LOL, Little old Lady

I check the ConsumerLab.com website before I purchase supplements to be sure I'm not wasting my money. This is a private independent laboratory that purchases nutritional supplements off the shelf and tests them to see if they contain what they claim in the amounts stated on their labels. They also test for harmful substances, such as PCBs found in some fish oils and lead in some calcium supplements. They post the results on their website.

If you depend on Vitamins and Supplements as I, the ConsumersLab.com mentioned in this article is one of the most valuable services I subscribe to. First it is Independent of drug companies, government agencies, and is owned, operated and administered by a medical doctor. They evaluate, test and report which brand of a given subject is acceptable by their standards (they tell you what their standards are for each item tested) and why other brands are ranked as Not-Acceptable. Their report details what to look for in that particular supplement and the why. Then a lot more information on that particular supplement, if you want to take time as I do because this gives me more insight and why I should use this supplement or why I might just drop it from my regiment.

It is amazing the difference between Brand A and Brand C, because I find that price is no indication of quality or value. After studying their report on any particular item I am then certain of my decision. So therefore being loyal to particular brands or label is not the deciding factor in my purchases. Because many cases this brand will have one of the best in quality and value on one particular supplement then on another they are at the bottom of the in rankings.

Don't misunderstand, there are some brands that in most cases will have top quality products, but not always. I'm well rewarded for the time I spend using this services because sometimes there can be a warning about a particular vitamin or supplement that will have a reaction with a medication, that the doctor or pharmacist overlooked cautioning about.

IMO if your serious about your health and going to take vitamins and supplements this should be your first priority.
Take a look at their web site; (1.) the list of companies tested (2.) and supplements reviewed, the front page of this web site will give you a comprehensive insight of what they have to offer, take a look; www.ConsumerLab.com

I think that there are private labs that periodically test supplements from specific manufacturers. There may be some cost for that information but it would be useful. Is anyone familiar with these labs? Not sure I would trust the FDA anyway. We (FDA) do such a poor job monitoring the drugs, especially generics, we claim to oversee.

This article is helpful. Thanks.

I did my own rough little quality control test of two probiotic capsules.

I use an encapsulated probiotic supplement that I purchase from my doctor's office. The live cultures contained in the supplement are supposed to be refrigerated at all times to keep the culture alive. I ran out and couldn't get to the doctor's office so I bought some at a store, out of the refrigerator there. It was a different brand, but the same cultures in the same numbers (they tell you how many "billions of organisms") were listed on the label. Then I got some from the doctor's office soon after.

I make my own yogurt at home and one day, as I was heating the milk I realized I had no yogurt culture on hand. I decided to try breaking open a capsule of my supplement to see if it would work. Since I had the two kinds, both purchased recently and refrigerated (to my knowledge anyway), I decided to do an experiment, so I incubated a batch of each. The one from the doctor's office grew nice yogurt, and the other didn't thicken at all, even with extra time. I'm no scientist, but in my simple mind it seemed to me this strongly suggests the capsules from the store were dead.

I learned that getting information from the lab mentioned in the above review costs $33 per year. I have been relieving symptoms and promoting my health in general with supplements for fifty three years. I was age 30 when I began.

I get my supplements online from a source I trust and from companies I trust. I can test most of them myself just from how I react to them, especially ones with a single ingredient. If I don't see improvement in my symptoms, I quit taking it. For example, I take 5,000 IU of Vitamin D3 daily and I have my doctor check my level every six months. It usually is about 50, which is exactly where I want it to be.

On the other hand, blindly taking supplements off a pharmacy shelf could be troublesome, I think, though not as troublesome as taking the wrong prescription drug at the wrong dose. As with anything, to be successful one must spend some time working at it.

There are reputable sites to help with wisely selecting supplements, and there are sites that just want your money.

And there are many sites that do not sell supplements that educate me. But you do have to care about your long term health enough to educate yourself. There are no specialist out there that can really help, and no government agency to test them and, if there were, the price likely would skyrocket. But this doesn't mean they are not extremely valuable.

I've been taking Vitamin C for about fifty years. Whenever I stop I catch a cold. Doctors have told me it doesn't help, I'm just more susceptible. Hah! I believe in Vitamin C.

What DOES the FDA do ??? And how can citizens work to help it become more effective?? How much good can even NATIONAL HEALTH INSURANCE do if the FEDERAL DRUG ADMINISTRATION, hopefully a source of reliable, useful and trusted data, is inadequate ??

Is there any solid informational basis in medications and healthcare available ANYWHERE ?? Or must American citizens be left in the lurch and have to pay $30.00 for every health question that comes along ? If I ran any health care business and my services were this suspect, I'd get SUED and soon be replaced by a more competent business !!

Even though I have osteopenia I had to quit taking calcium because I have extensive plaques in my arteries. I am relying only on vitamin D3, so this is scary reading. I exercise, but what else should I do?
Judy C.

We want the FDA to work both ways--to give us unlimited access to perfect drugs, and to keep everything that could be bad for us off the streets, and we don't want to pay taxes to make it happen, and we let pharma fund most of the FDA's activity in the form of the drug studies.

Won't work. Even if we practice believing six impossible things before breakfast.

Why don't we throw Monsanto and the safety of GM foods into the mix, while we're at it?

Some of us believe in mega-dosing. Some of us believe in un-pasteurization. The FDA would prevent both. According to the FDA, the RDA for D is 400 units. That won't move my needle.

Some of us are willing to self-educate, to believe that (mostly) you get what you pay for, and stuff sold at super-low prices probably not good as stuff from reliable sources.

We want our drugs at Canadian prices and we don't want to know what China puts in our supplies, despite multiple incidents telling us they have different standards for safety. We're Shocked! Shocked! that some businesses will actually buy from India and pretend to be Canadian.

In other words, this whole arena is a swamp. Life is messy. Get used to it.

You want an FDA with teeth? Pony up. THAT COSTS (TAX) MONEY.

Did Dr. LeBlanc's team find that a particular brand/s fared less trustworthy than another or was it a recurring theme among all of the manufacturers across the board? Often, the same supplement can have a substantially higher price tag among the various producers. Was any conclusion reached in that regard, that tended to support the fact that the higher priced had the higher quality? I suspect no, but I'm curious.

Can anyone trust some of the STAMPS of approval on the bottles as valid test authorities? I have in my cabinet 3 different products that have an approval from an alleged trusted authority. They are the following: 1. Vitamin C Product labeled with-- USP -Dietary Supplement Verified. #2. Vitamin D3 bottle-- their Symbol- a red check mark across the letters QA and circled around the symbol- the wording "Quality Assured" and the #3 bottle is Potassium- Quality Assured Guarantee with Green check mark with side wording that the product is produced under strict quality assurance and Certtifed by an ISO 9001:2000 certified laboratory.

All 3 are different manufacturers alleging via these separate and distinct symbols to meet standards. Are these manufacturers and their SYMBOLS to be believed? Is there any truly certified rating organization (other than FDA) that can assure consumers of the material content of a given vitamin, mineral, etc. or are these stamps used more as a marketing tool?

Does this industry try to police itself?

Good points, JFR. Not everyone can afford to or wants to pay money to find out whether the supplement they are purchasing is what it's supposed to be - nor should we have to. Personally, I don't mind the fee. But your sensible method seems to be working great for you. Hats off!

Follow the money trail. The FDA tried to gain control in 1994 with legislation, but the manufacturers of supplements mounted a fierce campaign against any controls and congress caved. Until money is removed from politics, the outcome will remain the same.
vn

1 question is unanswered and I ask the People's Pharmacy to answer it. Can you trust a product that has the USP seal on it?

Additionally I just purchased some vitamins for a now unnamed source which I thought reliable. 2 of the products had a specific note on them not to refrigerate, which I assume means cooling is deleterious to the product. Their website does not disclose this. Had I known I would not have bought these 2 items in the dead of winter- the products are Vitamin E mixed Tocopherols and Ribose. I am waiting to see if the source makes it right. At best this is a devious practice.

My understanding is that the FDA does NOT regulate supplements, with the exception that the supplement manufacturers/distributors must not advertise that they cure whatever illness. The FDA does NOT test the supplements; they only monitor the advertisement.

Regarding Consumer Labs, I subscribe yearly because I find their information very useful. Since they don't advertise and are NOT supported by the snake oil salesmen or even legitimate manufacturers, their research is costly and time-consuming. By the way, they do provide a lot of information for free, but their complete test reports require a subscription. Check out: www.consumerlab.com

ConsumerLab ain't perfect, but it's pretty good. They're constantly updating quality information about a wide range of supplements. Definitely worth the annual fee. Way better at what they do than FDA would be. FDA is controlled by Big Pharma, and it would act to put all supplements under Big Pharma's control. Which is to say, to make supplements scarce and expensive (and no more reliable!).

I see an endocrinologist every three months. My vitamin D level goes up and down. I realized that I was buying different brands. Next I read an article that some brands work and others do not. I found a brand that worked for me and stayed with it.

Thanks for this altert. And thanks for all you are doing through the People's Pharmacy. I have been a regular listener for years.

After reading about problems with our medicine supply I began to have serious doubts about the quality of supplements. This altert confirms my suspecions.

Notice that labs will not test a medicine or supplement for a consumer.

Also notice that labs testing for the manufacturer are probably no more to be trusted than the Better Business Bureau.

And even if a lab would test for consumers, I have been told that the cost of testing would be prohibitively high for an individual.

So here is another example of the "naivity" of "deregulation." Or stated another way, the governments failure to punish wrong doers.

I heard the other day that the government is doing (or may have completed?) a study on the efficacy of using multivitamins. If this study is correct, this study is a total waste of taxpayer money! The question is: How can we get someone to "mind the store?"

You say you exercise, which is great, but certain exercise is better for what you say you have. Note: some question that that condition exists. In any event you should speak to a certified trainer or better yet a PT. Generally weight bearing exercise (walking) and resistance training (weight lifting which is not as scary as it sounds) are recommended for building bone which is alive and which reacts in a positive way (gets stronger) to stressors (walking and lifting.)

I subscribed to ConsumerLab.com for awhile. The brands they tested were ones sold in grocery stores and commercial drug stores. This site did not provide me with information on the brands sold at stores dedicated to selling natural foods and high quality vitamins and other supplements.

Yes, we would all benefit from checks and balances on contents and quantities in supplements, and, getting our government involved in not the way to go. Self-policing by the supplement industry makes much more sense. There are those in government that would love to regulate the supplement industry, and use that as a path to shut it down. Pharmaceutical companies have enormous control in government, and supplement companies are their biggest competitors.

The World Health Organization is working non-stop for international regulation of supplements. Germany is a great example of how this has gone so wrong. One must have a prescription from a doctor to obtain any supplement that exceeds what the government sets as the daily standard amount. Should you have a cold and want to high-dose vitamin C, you have to see and doctor and get a prescription. This is what happens when the government gets involved.

So YES! to checks and balances, but let's do this within our own industry and maintain control of our own destiny.

Wise thoughts, Karen. There are many sides to consider. We all put the effort into this we think it is worth and hope for the best. As the population has grown, as fewer people fear God, which I think is a good thing, and as large impersonal cities have replaced small communities where everybody knew everybody; it seems to me ethics have declined, and you can't legislate ethics.

Jeff, I don't know if you work for a supplement company or not but it sure sounds like it. Being charitable, maybe you didn't read the above carefully.
Restated 2/3rds of the pills tested failed the test to be w/in + or - 10% of what was supposed to be in the pill.
This should be scary to you. You call for self-regulation, but isn't that what is now going on? And failing miserably.

I restate my earlier question to the Graedons: "If a supplement has the USP seal on it, can we trust it to meet the USP standard." I am not looking for yes or no, but an explanation of how they test, how the sample and what degree of reliance is warranted by that seal.
Thank you.

Wow, Jeff. I didn't know about the situation in Germany. We certainly don't want that! I agree that getting the government involved would create more problems. But I'm not sure that self-policing by the supplement industry is the answer, either. Wouldn't that be like trusting the fox to guard the chicken house?

I don't think you need a connection to the supplement industry (and I don't have one) to agree with Jeff (and I do, in part). I think one way things have gone wrong is consumers' heavy reliance on products we have no power to check out ourselves. With all the criticism of the FDA that has gone on, and the many huge blunders it has made, I don't really understand why there is a hue and cry for more FDA regulation of ever more products.

Industry will always spend all the money it can to get its products approved, marketed, and promoted, whether it is through influencing regulators and regulatory process or by making claims of quality, some of which turn out to be untrue for whatever reason. Government regulation and industry self-regulation are two sides of the same coin: human nature is at work in all its fallibility and hubris. Reading over the comments to this article, together with the comments on the other newsletter article on the vegetable oil studies, I'm thinking it's better to pay less attention to government as well as industry advice about what to ingest, and simply eat whole, natural foods, the origins and 'processing' of which I can check out for myself, and the sellers of which consume it themselves and know they'll have to face me - directly - if something goes wrong. It is a difficult transition to make.

I've been spending a lot of time getting acquainted with my own body, reactions, and needs, finding local growers, and relying less on the latest news on the latest health claim. It's time consuming and seems expensive at times. But it isn't nearly as expensive as buying supplements that do nothing (or worse), or paying ever higher taxes for regulations that are poorly written, executed or enforced. What do we do in our lives that is more important than seeking quality nourishment? That has become my priority, and I have begun to realize that the increased time spent is worth it in terms of better health. The higher prices paid for the food I need for optimal health work out because I spend less on supplements. Michael Pollan is right!

Due to changes in "medical opinion", we have been "on" and "off" supplements like Vit. C, Vit D, Calcium, fish oil and others for years, and worry all the time that we are doing the wrong thing no matter WHAT we are/are not doing.

People's Pharmacy: You're great, but can't you give us a reply to the question, "If it says USP on the container, can we assume the product is what it says it is?

This is a very vexatious question and we need some going out on the limb.

Thanks,
Naomi Baxter

PEOPLE'S PHARMACY RESPONSE: We'll be following up with USP about this soon.

Yes, please, Joe and Terry! Please answer this question: If it says USP on the container, can we assume the product is what it says it is? I'm starting to wonder if you read these posts.

PEOPLE'S PHARMACY: We'll confirm with USP what their procedure is to monitor quality and let you know.

I raised the USP question on 2/12. I don't understand the reluctance of the experts to dive in since the issue goes to the whole issue of the thread they started: Can you trust supplements to contain the amount of active ingredient stated? If USP is reliable, many of us would seek out their seal on products and it might have the effect of making non-USP endorsed companies correct their quality control and become USP certified. Maybe a radio show with a spokesman from USP could be done. Most who follow this site are serious about these things and USP is a serious question. Thank you and we look forward to your response.

I am interested in compounding a general SUPPORT multivitamin/mineral supplement.
I have a b6 sensitivity. Have not been on a multi vitamin for at least 5 years - recovering from the toxicity and nerve issues. So b6 is out.

I need to know which other vitamins/minerals (combination) are the most important for a 48 year old woman experiencing peri menopause, who is also hypo thyroid.

My doctor says it is now time for a vitamin. I can take myself to get my blood levels tested.
Which vitamin and mineral tests do I need? Are some more important then others..more recommended?
Could use some guidance. Then discuss and have the doctor write me a prescription.
Can anyone help me?

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