Does taking 22 pills a day make you any healthier?

TIME magazine’s senior writer John Cloud recently pondered the question of nutraceutical dietary supplements in this way:

“Vitamins, probiotics, omega-3 capsules, antioxidant pills: they can’t hurt, right? Around the corner of each advancing birthday lurks a possible affliction –  arthritis, cancer, Alzheimer’s – and a giant industry has emerged to try to prevent them all.

“North Americans now spend an estimated $28 billion a year on dietary supplements –  more than twice what we spent in 1995 and more than $5 billion more than what we pay each year for gym memberships. But do supplements actually work?”

Here’s what happened to John:     ,    

He had a panel of blood tests done before and after a five-month experiment with dietary supplements recommended for him by USANA, the Utah-based multilevel marketing company (in which distributors recruit and profit from other distributors).

In John’s personal experiment, he consumed 22 different pills a day, along with health shakes, protein bars and psyllium fibre supplements.  His conclusion: these nutraceutical supplements made no difference to his overall health.

Only two of his clinical measurements changed significantly:

  • his vitamin D level went up (which he could have raised much more cheaply with a generic vitamin D tablet, and which he further  attributed to the weather (his before tests were done in January, the after in sunny June when he spent more time outdoors). Institute of Medicine guidelines based on over 1,000 published scientific studies now recommend that most North Americans up to age 70 need no more than 600 international units (IUs) of vitamin D per day to maintain health (800 IUs for those 71 and older).
  • his HDL (good) cholesterol level went up (which was unexplained by the supplements)

He reported that he felt better while taking the supplements for five months, but he attributed that to the placebo effect.

But he had one unfortunate side effect: he gained 10 pounds over the first two months, which he chalked up to what psychologists call the licensing effect:

“You allow yourself to do something bad (like eating more cheeseburgers,  fries, and onion rings) after you’ve done something good for yourself!”

An August 2011 study published in the journal Addiction shows that the same licensing effect can happen with smokers: those who took pills they believed were vitamins – actually just sugar pills – smoked significantly more cigarettes afterward than those in a control group.

John Cloud wrote that he felt virtuous. He knew he was getting his nutrition in the pills, so he felt licensed to eat a less healthy diet with more calories. He managed to lose the weight, but it took him three months. (USANA officials reminded him at the time that their daily nutraceutical supplements should be accompanied by physical exercise, eating healthy foods, drinking lots of water and getting enough sleep).  Which begs the question, of course:

If you did those four things every day, wouldn’t you’d be healthier anyway without having to take any pills?

In his subsequent TIME article, “Nutrition In a Pill“, he discusses the history of vitamins and the inconclusive science behind supplement recommendations. He provides insight into the way nutraceuticals are marketed. He interviews skeptical scientists including one who calls the vitamin business “the damnedest racket ever perpetrated upon the public.”

John Cloud’s own conclusion:

“On nutraceuticals, I had come to believe that health could be a set of tablets to take rather than a series of responsibilities to meet – water instead of soda, an apple instead of chips, real fish instead of a giant fish-oil capsule.

“You can take vitamins on the faith that they will make you better and if you have a real vitamin deficiency, they will.

“But there’s more science behind another way of getting your vitamins: eating right.”

He added that some nutriceuticals might be appropriate for some people with measurable deficiencies in certain vitamins or minerals, but advised against trusting the educational pitch from your local health food store clerk, which may mean walking out of the store with $200 worth of supplements that you may or may not need.  This is particularly true if you are already taking prescribed medications (some supplements, for example, should not be consumed by those taking certain heart meds).

His (admittedly small one-person) experiment is not particularly good news for USANA or other commercial sellers of nutraceutical supplements. USANA, by the way, earned $565 million in revenue over the previous 12 months, which actually makes it one of the smaller players in the nutraceutical world, says John Cloud. The world’s largest pharmaceutical company, Pfizer, sold an estimated $463 million in supplements (like its Centrum vitamin) last year in North America alone, according to the Nutrition Business Journal. By comparison, GNC (a brand of dietary supplements you may recognize from your local mall) reported annual revenues of $1.93 billion.

Meanwhile, as the National Business Review reported, USANA’s own company documents show:

  • USANA distributors follow a “binary compensation plan,” in which one person recruits two others, those two recruit four others, those four recruit eight others, and so on
  • each new USANA distributor must buy a minimum amount of the company’s business tools and health products to get started, and then continue to buy a minimum amount of its health products every month thereafter in order to qualify for commissions
  • 87% of commission-earning USANA distributors did not make enough to recoup the cost of their monthly qualifying purchases
  • the top 7.7% of USANA’s commission-earning distributors made 72.2% of the company’s commissions
  • the company has a “significant turnover” in its distributors every year according to its 2006 SEC filings, and so it “must continually recruit” new distributors.

The bottom line, according to statistician Dr. Murray H. Smith, is that the vast majority of USANA distributors end up paying more to qualify for commissions than they actually make in commissions:

“Most people won’t get their money back.”

.

20 thoughts on “Does taking 22 pills a day make you any healthier?

  1. This was an interesting journey and article in Time. The best way to get the nutrition we need is via food. However there is a role for judicious use of supplements. It staggers me how many people in Australia are deficient in vitamins (as evidenced on blood testing). Personally I take a fish oil made by USANA, but buy it as I would buy any other product, not to make money.

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    • Hello Dr. Joe – I too take fish oil (plus Co-Q-10, recommended for heart attack survivors). As this article concludes, supplements “might be appropriate for some people with measurable vitamin/mineral deficiencies” – but most people I know who buy supplements do so right off the shelf without any blood testing at all.

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  2. “His (admittedly small one-person experiment) is not particularly good news”.
    Ahem.
    Well, it is merely NO NEWS. It is a paper in a magazine. This is a nonsensical experiment, that is doomed from its conception to not produce any usable data.
    One patient is of course a joke as noted.
    It could be a one patient experiment if it were a blinded crossover study, patient his own control. Placebo for one period, Treatment for another with appropriate concealment and crossing over and randomised determination of treatment order with a sufficient wash out period in between.
    Outcomes are nonsensical since they are surrogate outcomes.
    Not that I am a fanatic of supplements.

    A word on quoting the “Institute of Medicine guidelines based on over 1,000 published scientific studies”. Guidelines based on zillions studies can be widely off the mark. Most studies on vitamin D use low doses (less than 1000 units daily) and test surrogate endpoints (osteodensitometry) and care only about bone. Which is shortsighted with such a steroid vitamin/hormone. The truth is we do not know so we do not “know” that we should not take more than 800 units after any age.
    I would like to know what the “Darwinian” view would tell us: what is the skin production when living out in the nude with sweet weather. That would not be a proof either but might tell us what the serum levels could reach.

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    • Hello Maurice – John’s “experiment” is of course not destined for publication in a peer-reviewed journal, nor would it claim to be. What is does show is simply one man’s experience with an industry marketing machine that is largely unregulated.
      cheers,
      C.

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  3. It’s a great shame that the two divergent stories in this piece, got all mixed up and rolled into one.

    The business of MLM companies such as USANA co-opting completely unqualified members of the public into flogging over-priced products is just plain dangerous. As a past member of the Society for Integrative Oncology, and having worked alongside Naturopaths who qualified with mainstream Health Science degrees, I know that there is a time and place for the judicious use of nutritional supplements in various population groups whose illness and medical treatments cause macro and micronutrional deficiencies.

    In this article, TIME has merely published one anecdotal account of one – healthy – person’s experience of ingesting a pile of stuff without the assessment and guidance of an appropriately qualified Nutritionist or Naturopath.

    The article is an opinion piece, and cannot contribute much to the credible Evidence Base for nutritional supplementation.

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    • Hi Margi – John’s piece doesn’t pretend to be anything but what it is, which is why I find it more compelling than the sales pitch of your typical health food store or Walmart clerk. In my experience, most of the people I know who are purchasing supplements do so because they’ve read a magazine article or watched some guy on television recommend yet another miracle vitamin. They don’t get them from naturopaths or nutritionists, or after blood test results that indicate “measurable vitamin/mineral deficiencies”.
      cheers,
      C.

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      • Most people, as Carolyn implied, will buy their supplements simply on the advice of their next door neighbor’s aunt whose daughter-in-law used them and liked them.

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  4. I’ve been researching USANA for the last 5 years and I’m not at all surprised by the conclusion John has made. I have a follow up question for John: How much did you spend on USANA vitamins during the five month period and would you recommend your readers to spend that kind of money on these supplements?

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    • In his article, John writes that his five-month supply of nutriceuticals cost $1,200. He described his experience with USANA quite positively (“very straightforward”). Read the rest of his TIME article here.
      cheers,
      C.

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      • Carolyn,

        What do you think about the fact that USANA’s online “Product Advisor” that John Cloud used to determine which USANA vitamins he needs, is flawed? It doesn’t matter if you put every answer as the best possible choice, USANA recommends at least $100 worth of product each month (mainly due to the fact USANA requires a mandatory purchase by its distributors of at least $100 worth of product every month in order to participate in the business opportunity). That is fraud if you ask me. I’ve been researching USANA for over 5 years now and the one responsible for those statistics you get from National Business Review.

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        • It is in the best interests of the shareholders of EVERY company selling ANYTHING to convince consumers that we “need” to purchase their products. And the more we buy, the better it is for them. It is especially in the best interests of those selling nutriceutical supplements to convince us that we cannot survive on a diet of healthy food without purchasing their products.

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  5. Certainly this Time mag paper does not pretend much yet it does conveys wrong messages to a huge reading audience (that sounds weird, a reading audience, ay be a reader body would suit better ? Sorry, not a native speaker) :

    – that anything can be assessed through one anecdotal experiment. WHich many hold true.
    – that surrogate endpoints such as lipid profile mean anything. Which is deepply wrong. People are happy with a low cholesterol yet have a highly deleterious way of life (diet, activity etc.) and end up with sudden death or CCU care in the hospital.

    Doing so it contributes to further entrench deleterious wrong messages in the readers’ minds.
    It’s an amusing piece of humomr at best. I think USANA could be better criticised.

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  6. Carolyn, if you will allow me, I want to digress to the issue of ethics and marketing. I’m responding to your post above, and quoted here:

    “It is in the best interests of the shareholders of EVERY company selling ANYTHING to convince consumers that we “need” to purchase their products. And the more we buy, the better it is for them.”

    I certainly know what you’re talking about but when it comes to ethics, it is blatantly wrong. Needing to sell something isn’t enough reason to convince people they actually need to buy it when the seller has no reason to believe they do need what he’s selling. It is especially wrong to convince them they need it To Be Healthy when the seller has no idea if that is true.

    I may be living in outer space, but I just don’t think it is right nor should it be necessary to try to sell anything to anyone just because the seller wants to make money. Why can’t sellers find something buyers will want to buy without being “sold” a bill of goods to convince them they need it? Can’t sellers just allow the buyer to decide for him or herself? It seems like we’ve gotten a long way from right and wrong in this society, and this is a perfect example. There are a lot of claims made on products someone wants to sell that seem to me to be flat out lies. How is it that we just shrug that off?

    Does this issue have meaning for other readers here? Am I just too old fashioned?

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    • Hello Bev – no, you’re not living in outer space! I think there are many of us out here who are increasingly alarmed by what’s become known as “marketing-based medicine” – in fact,one of the reasons I launched The Ethical Nag two years ago was the fistful of daily cardiac meds I was suddenly prescribed following my heart attack. The more I learned about the pervasive influence of Big Pharma on medicine, the more I realized that I have no clue which of those drugs were prescribed for me based on flawed research and tainted medical journal articles – and worse, neither do my doctors!

      Thanks for your comments here.
      cheers,
      C.

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  7. Mr. Cloud conducted an independent study with no comparison to other products. He went on to blame the products for his weight gain. He admits to starting his study in January finishing in June, usually the time when most people sit indoors and don’t get their daily exercise. Mr. Cloud also mentioned “the licensing effect” which he used as a reason to eat more cheeseburgers, fries, and onion rings.

    Blaming poor food choices on a nutritional supplements is something like saying that since I’m wearing a helmet I’ll hit myself in the head with a baseball bat. I would like to know what his blood results would have been had he not been taking the USANA Supplements. I challenge him to conduct the same study from January to June 2014 using products like Centrum, One-A-Day or something from a local vitamin store. I think he will be astounded by the results.

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    • Hello Rob – Cloud doesn’t “blame” the supplements for his weight gain. He quite clearly attributes this to the commonly described “licensing effect”. In essence, you seem to be agreeing with his take-away message (“getting your vitamins by eating right”) without actually disclosing your conflict of interest as a USANA dealer.

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  8. Dear Carolyn Thomas: I have kept all of my posts beginning May 20, 2013 at 11:12 am. You have refused to post subsequent posts after this date because they are not in your best interest. I request that you cease and desist (contact your attorney about the meaning of this term) the posting of my post on the date of May 20, 2013 at 11:12 am. 3rd notice: June 29, 2013 at 10:43 am.

    You have 30 days to remove the post dated May 20, 2013 at 11:12 am. I have asked you to remove that post because you failed to let me post my rebuttal to your comment. Since you refused my rebuttal and you fail to remove the post I will wait until July 31, 2013.

    If my original post is not delete I will contact my attorney to take legal action for failing to remove the post dated May 20, 2013 at 11:12 am after you were sent the cease and desist order three times. Good day.

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  9. Hey Rob, I just read your post. You sound really frustrated! Seriously, try to relax a little. I know when I write something to include here or on someone else’s site, I always wonder if it’ll show up. I try to offer something pertinent and coherent, and so far what I’ve offered has been posted. Still, if it isn’t someday, my thinking is, “Well, that’s their prerogative. Their site, their call.” and let it go.

    Carolyn, I like your disclaimers. Excellent. You let me and everyone else know how things run right at the outset. You are a straight up, true blue member of the subcategory of the human race known as “honest humans” (aka honest humen, haha). Is there any worry about the extinction of this subcategory?

    Best to you both. But hey, wait a minute. Rob, are you really a salesman for those pills that guy took? Why didn’t you say so? It makes me wonder about your honesty now for not saying so. If you’d just spoken up, I’d have wanted to ask you a lot of things about the supplements. Well, it’s okay. I’m too busy right now to pay attention to answers anyway.

    Carolyn, Rob – Y’all have a great day!

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