Eat, Drink and Be Wary: The Truth about Diet Supplements and Sports Drinks


Dear Readers,

For whatever reason — no time to cook, picky palates, fondness for fast food — Americans are always looking for ways to enhance their diets and improve their fitness that don’t involve consuming actual food. The market for vitamin/mineral/herb supplements and energy/sports drinks is strong and growing.

The truth is different. If you don’t have a diagnosed disorder whose treatment requires nutritional supplementation, swallowing these products is wasteful at best and harmful at worst. This month, I review recent research that reinforces the folly of using products whose benefits just aren’t there.

Diet Supplements: Not a Fruit, Not a Vegetable, Not Worth Taking

People have a lot of reasons for taking diet supplements: weight loss, disease prevention, overall fitness, an energy booster. A recent study by the National Institutes of Health (NIH) concluded that “Sales of dietary supplements increased from $8.8 billion in 1994 to an estimated $15.7 billion in 2000 and $18.8 billion in 2003…” a doubling of their popularity in ten years.

Do people use them because they work, or because they are led to believe they will work?

Supplements are regulated by the FDA separately from foods and drugs. Their manufacturers are not allowed to claim to “diagnose, treat, cure or prevent any disease”; they may, however, claim to support the “structure and function of the body.”

That distinction is so fuzzy as to be meaningless. More important is that before the FDA may remove a dietary supplement from the market, the FDA must prove the product unsafe. That’s a reversal of the usual rule that a manufacturer must prove its product safe to get on the market in the first place. But diet supplements have friends in high places who got favorable federal legislation passed years ago to protect the profits of the diet supplement industry. (Hint: Utah is the state where many of those supplement companies are located.)

Concerns about the safety particularly of herbal products (for example, ginseng and echinacea) arise because: consumers are less likely to report adverse effects; herbs might be adulterated; herbs potentially might interact with therapeutic drugs. Most people who take supplements, the NIH study found, don’t tell their medical providers who, they believe, are prejudiced against their use.

There are very few scientific studies on the safety or efficacy of the numerous dietary supplements. The NIH study found that “many believed they are evaluated for safety and efficacy by the … FDA before marketing, and that dietary supplements are safer than over-the-counter (OTC) or prescription medications.”

Not true at all.

Those folks, apparently, don’t remember ephedra. The FDA removed products containing ephedra from the market in 2004 after multiple reports of heart and nervous system problems. MedPage Today recently reported on data from the Drug Induced Liver Injury Network, which evaluated U.S. patient information from 2003 to 2011. The numbers were shocking: Supplements were deemed responsible for nearly 1 in 5 liver injuries. Researchers concluded that taking herbal and dietary supplements put some people at risk for liver injuries serious enough to warrant an organ transplant.

Also reported on MedPage Today was a story about a pain “remedy” called Reumofan Plus. The FDA issued a warning about it, a so-called “natural” dietary supplement manufactured in Mexico, after receiving several adverse events reports including liver injury, worsening of blood sugar control, swelling and weight gain. As it turned out, the product contained two prescription drugs; one is known to cause cardiovascular and gastrointestinal problems and the other can cause sedation and dizziness.

The Mexican Ministry of Health ordered a product recall.

And there’s a prevailing sense that if a supplement is a vitamin or mineral, it can’t harm you. Ssome can’t, but some can. Vitamins are either water-soluble or fat-soluble. Water-soluble B and C vitamins are rapidly excreted in the urine. Fat-soluble A, D, E and K vitamins are stored in body fat, eliminated slowly and, in large doses, carry the potential to do real harm. Large doses of vitamin A can be toxic to the liver and threatens developing fetuses with birth defects; vitamin E can be toxic to the heart; Vitamin D (as we reported on our patient safety blog) can cause kidney stones, nausea and muscle weakness.

My point isn’t to list all the problems that might result from taking supplements-that would take until the 12th of never.

Nor is it to suggest that some vitamins and herbs might not be helpful for some people. The point is to remind consumers that routinely taking vitamins, minerals and herbal supplements is a leap of faith, not a vote for science.

After a review of several popular supplements and vitamins, the Harvard Men’s Health Watch cautioned: “[I]n most cases, the studies have failed to confirm our hopes, though there are exceptions.” And in the words of the Harvard Medical School health newsletter, “Despite their popularity, there is no evidence that multivitamins enhance health or prevent illness. In fact, both the U.S. Preventive Services Task Force and a National Institutes of Health State-of-the-Science Conference concluded that multivitamins do not offer protection against heart disease or cancer.”

Here’s more about vitamins from our patient safety blog, with some good links to other resources.

Sports Drinks: Many Claims, Little Evidence of Benefit

Ten years ago, did anyone foresee “vitamin water”? Is it really just the natural progression from the energy and sports drinks we love so much? According to Global Data, a research and analysis enterprise, from 2010 to 2011 sales of sports drinks reached $3.9 billion in the U.S. But as expertly described in a series of seven articles in the British Medical Journal (BMJ), sports and energy drinks also fall short as health aids for most people.

As recounted on Weighty Matters,  an obesity doctor’s blog about the state of the nutritional science art, BMJ researchers identified an astonishing 431 performance enhancing claims for 104 different sports/energy drink products. Of the manufacturers’ claims about product efficacy, researchers found that more than 8 in 10 were “judged to be at high risk of bias.” Only three were deemed to be of high quality and of low risk of bias.

Is it any surprise that they concluded “The current evidence is not of sufficient quality to inform the public about the benefits and harms of sports products”?

Our patient safety blog recently raised the flag of concern about the contents of energy drinks. Basically, these drinks are all about caffeine, but how much of it and what company it keeps with other ingredients can be a mystery. For sensitive people, that can spell trouble. The Journal of the American Medical Association published an article with a title that says it all: “The High Risk of Energy Drinks.”

Better Habits Beat Supplements in the Goal of Improving Health 

Before you opt for nutritional supplementation, whether vitamins, minerals, herbs or drinks, consider your motives. To address poor eating habits? Fight disease? Alleviate pain? Lose weight? Boost energy?

All these issues can — and for most people should — be resolved by changes in behavior and maybe medical diagnosis and treatment.

No one has a quick fix.

But eating properly and regularly is a better means of metabolizing nutrients than chemical piling on. Getting sufficient sleep and exercising regularly are much safer and more enduring ways of heading off disease and improving health and fitness than popping pills and quaffing drinks that might have a beneficial effect but probably don’t and that might do real harm.

If you’re considering taking supplements, Harvard Medical School Healthbeat says:

  • Be wary of extravagant claims, testimonials and endorsement.
  • Be aware of meaningless terms including “all-natural,” “anti-oxidant rich,” “clinically proven,” “anti-aging,” and anything similarly vague.
  • Don’t believe that “if a little is good, more is better.” In fact, more could have unintended adverse effects.
  • Always inform your caregivers about any supplements you take.

Active people who want to ensure proper hydration should, simply, drink water when they’re thirsty; unless you’re an elite athlete or are active longer than a couple of hours, you needn’t worry about drinking more often than your body tells you to, or about replacing nutrients.


To your continued health!

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Patrick Malone
Patrick Malone & Associates