Why is there a supplement craze if they don’t even work?

One reason the $70 billion supplement industry is set to double in the next seven years? Lax regulation. On today's show, we tell the story of a century-long battle between the U. S. government and … you, the people, blinded by your love of a magic pill. We’re talking about protein powders, pre-workouts, creatine, stuff for gut health, joint health, vitamin C, turmeric supplements. All that. You might not wanna hear this. Sources mentioned in the episode: Marion Nestle, Food Politics https://www.foodpolitics.com/food-politics-how-the-food-industry-influences-nutrition-and-health/Catherine Price, Vitamania https://books.google.com/books/about/Vitamania.html?id=I5eeBwAAQBAJ Support: Planet Money+ https://n.pr/3HlREPzRead: Our book: Planet Money: A Guide to the Economic Forces That Shape Your Life https://lnk.to/i3AukBdD Our weekly longform Planet Money newsletter https://n.pr/3zrFvUBOur weekly Indicator round-up newsletter https://www.npr.org/newsletter/indicatorFollow: Instagram https://n.pr/3FqLuwsTikTok https://n.pr/3sGZdrqYouTube https://lnk.to/iCVDaW3CFacebook https://n.pr/3h92GwS This episode was hosted by Sarah Gonzalez and Jane Black. It was produced by Sam Yellowhorse Kesler, edited by Marianne McCune, and fact checked by Sierra Juarez with help with Vito Emanuel. It was engineered by Robert Rodriguez with help from Jimmy Keeley. Alex Goldmark is Planet Money’s executive producer. See pcm.adswizz.com https://pcm.adswizz.com for information about our collection and use of personal data for sponsorship and to manage your podcast sponsorship preferences. NPR Privacy Policy https://www.npr.org/about-npr/179878450/privacy-policy

• 0:00Speaker 00

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• 0:15Speaker 01

  This is Planet Money from NPR.

• 0:20Speaker 02

  You may have noticed we are living in the midst of a supplement craze. People are Vitamax-ing, biohacking so they can live longer. Everyone's talking about gut health.

• 0:30Speaker 01

  I feel very aware of my gut health right now. It's true. The supplement industry is a $70 billion industry in the United States and growing fast. We are talking protein powders, pre-workouts, probiotics, fat burners.

• 0:45Speaker 02

  There's joint health, gut health, there's glowing skin. I love glowing skin.

• 0:49Speaker 01

  Better sleep, stronger nails, all of that.

• 0:51Speaker 02

  75% of Americans take supplements.

• 0:53Speaker 01

  A lot of people.

• 0:54Speaker 02

  Yeah, like 100,000 different options you can choose from.

• 0:57Speaker 01

  Now, supplements are everything from creatine or bovine colostrum, sometimes put in a martini, to your daily vitamin C gummies or echinacea. And because there are so many supplements out there, we kind of wanted to see like how easy it is to get a new supplement pill or gummy on the market.

• 1:15Speaker 02

  Like, could we make a supplement?

• 1:18Speaker 01

  OK, what if we want to make a supplement?

• 1:20Speaker 03

  OK.

• 1:21Speaker 01

  Like a real NPR Planet Money branded supplement.

• 1:27Speaker 03

  Awesome.

• 1:28Speaker 02

  This is Frank Cantone, the chiseled CEO of SMP Nutras Supplement Manufacturing Partner. They make supplements.

• 1:35Speaker 03

  Capsules, tablets, powders, soft gels, gummies.

• 1:39Speaker 02

  And then brands, or influencers, or podcasts sell them under their own labels.

• 1:45Speaker 01

  I think it would be cool to have like a little microphone-shaped gummy, or a little Planet, or a little money gummy. A money gummy?

• 1:52Speaker 03

  We could do those.

• 1:53Speaker 01

  Or maybe we do a powder that you just like add water to and down it real quick.

• 1:56Speaker 02

  And it's called the money shot.

• 1:58Speaker 01

  The money shot is the perfect name.

• 2:00Speaker 03

  First and foremost, I think what's important would be to define the market.

• 2:04Speaker 01

  Frank really wanted us to think about our Planet Money audience and what supplement you find people might want. You know, smart, busy, capable people.

• 2:15Speaker 03

  So do we want something that helps people focus, right? Do you want to help people have more energy? Is that the type of product that we want to offer?

• 2:23Speaker 01

  That sounds great. I'm always tired.

• 2:26Speaker 02

  There are so many supplements already out there that claim to help with brain function or focus. There's ashwagandha or theanine.

• 2:34Speaker 01

  But for our potential focus gummy or shot, Frank actually suggests creatine or lion's mane or other mushrooms if we want focus.

• 2:44Speaker 02

  Focus would be awesome. Also, I would like thicker hair.

• 2:47Speaker 03

  Okay.

• 2:48Speaker 02

  Can I do that?

• 2:49Speaker 03

  Yeah, I mean, we could add collagen to this cocktail, which would help with hair growth and hair thickness.

• 2:55Speaker 01

  Hold on, we're gonna have a gummy that's like it gives you focus and it gives you thicker hair?

• 3:00Speaker 03

  It's doable, for sure.

• 3:02Speaker 01

  Is it smart?

• 3:05Speaker 03

  I feel like it it hits two needs that everyone really has a problem with, right?

• 3:11Speaker 02

  I love how Frank just wants to make things happen for us.

• 3:15Speaker 01

  I know. If there is something that you want your mind or your body to do, Frank will find the ingredient for you. Like, uh, you wanna burn fat? Maybe throw some green tea in there.

• 3:26Speaker 02

  Frank says people associate it with weight loss.

• 3:29Speaker 03

  It's typically found in weight management products, so they can kind of put it in that boat if they want to, but the green tea is really there for some energy benefits.

• 3:40Speaker 02

  We walked through all the things, ingredients, shapes, flavors.

• 3:44Speaker 01

  Kiwi?

• 3:44Speaker 03

  For sure.

• 3:45Speaker 01

  Honeydew? Honeydew is a super good flavor.

• 3:47Speaker 03

  No one does just kiwi.

• 3:50Speaker 01

  Oh.

• 3:50Speaker 03

  They do strawberry kiwi.

• 3:52Speaker 02

  We talked colors. Ours would be green, of course. And right there on the spot.

• 3:58Speaker 01

  We got an estimate for the smallest possible order of our fully customized, I would argue, very tasty supplement.

• 4:07Speaker 03

  It's going to be around 8,333 bottles. Based upon the ingredients we're talking about, it's going to range from like $4.50 to $7.

• 4:16Speaker 01

  $4 times 8,300 ish bottles?

• 4:19Speaker 03

  Mm-hmm.

• 4:19Speaker 01

  So 33,000 and then you do half upfront.

• 4:22Speaker 02

  Which is not that bad if you're looking to start your own business, but there is a cheaper option, too.

• 4:27Speaker 03

  For our stock formulas, you're in the game for, you know, 5,500 bucks.

• 4:33Speaker 01

  Yeah, they do have more than 800 gummies and pills and powders ready to go already. These are their stock options that we can just slap our own Planet Money label on and call it our special Planet Money Energy Supplement, even though this exact same gummy, same color, same flavor, same shape, is being sold already by someone else under a different label.

• 4:59Speaker 03

  Be happy to send you samples right after this call and you could try that energy gummy on the website.

• 5:03Speaker 02

  Yep, they even had an energy gummy with green tea in it.

• 5:08Speaker 01

  So could we say on the label, like, this will help with mental clarity and burn fat?

• 5:19Speaker 03

  We'll guide you down the right way to say it. I might say supports metabolism.

• 5:25Speaker 01

  Oh.

• 5:26Speaker 03

  Or, you know.

• 5:27Speaker 01

  I like that. Okay, supports metabolism.

• 5:31Speaker 03

  Exactly.

• 5:33Speaker 01

  Hello and welcome to Planet Money. I'm Sarah Gonzalez.

• 5:36Speaker 02

  And I'm Jane Black.

• 5:37Speaker 01

  Jane is a food politics reporter in DC. She has been watching what people call big wellness, get bigger and bigger and more and more powerful.

• 5:45Speaker 02

  And if you think supplements are popular now, just wait. Sales are expected to double over the next seven years.

• 5:52Speaker 01

  Now, we are not going to make our own supplement.

• 5:55Speaker 02

  We are not going to sell one.

• 5:57Speaker 01

  We were gonna do it.

• 5:58Speaker 02

  We were gonna do it.

• 5:59Speaker 01

  We were gonna do it.

• 5:59Speaker 02

  You know, it started to make us a little bit nervous.

• 6:02Speaker 01

  Which is kind of a bummer because we do want more energy.

• 6:05Speaker 02

  And thicker hair.

• 6:07Speaker 01

  And thicker hair, apparently.

• 6:09Speaker 02

  It was so tempting, especially because it's just so easy to make one.

• 6:16Speaker 01

  The supplement industry has been fully cashing in on our love of silver bullets and a magic pill.

• 6:24Speaker 02

  Today on the show, how lax regulations are making that possible.

• 6:29Speaker 01

  And why Americans wouldn't have it any other way.

• 6:33Speaker 02

  Yeah, like, what do you take?

• 6:35Speaker 03

  Definitely taking a multivitamin, taking magnesium before bed, berberine typically before a heavy meal, taking trace minerals, take some Dian Dolly methane, or on K2 and D3 in a fat soluble soft gel, 15 grams of creatine before my second coffee.

• 6:51Speaker 02

  Frank, this is so many supplements.

• 6:54Speaker 03

  It's not as many as you would think. It's like, on a given day, six or seven.

• 7:00Speaker 04

  Stay tuned for the following announcements and messages from our sponsors. This message comes from LinkedIn. Owning a small business comes with a lot of challenges and means juggling multiple things at once. It's even harder to do it efficiently. But with LinkedIn, you get all the tools you need to grow in one place. With LinkedIn, simplify your sales, marketing, and hiring so that you can actually run your small business. Learn more at LinkedIn.com/PlanetMoneyShow. This message comes from Rula. World Mental Health Day takes place in October, making it a great time to take that next step in getting support if you need it. Rula makes accessing quality mental health care affordable with sessions costing an average of $15 with insurance.

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• 8:09Speaker 02

  Okay, we are not here to prove or disprove whether supplements work, but we do want to say that experts and scientists tend to agree there is no evidence that supplements make healthy people healthier.

• 8:24Speaker 01

  Now, if you're pregnant, there is evidence that folic acid decreases the risk of certain birth defects. And if you have a condition or you're deficient in something, like you're anemic or deficient in iron, then yeah, sure. An iron supplement could help with that if a doctor recommends it. But if you're not deficient, then you probably don't need it. Frank Cantone, the supplement maker who takes not that many supplements every day, he is a big believer in supplements. Frank came to the supplement business from the real estate and clothing and thoroughbred racehorse trainer business. And his social media is still pretty horse-heavy.

• 9:06Speaker 03

  I just get vitamins, ads, and horse ads. That's all I got.

• 9:10Speaker 01

  Oh, okay.

• 9:12Speaker 02

  But now Frank knows a lot about supplements. He has built this huge supplement factory in Florida that he says makes millions of supplements a year. And he wants the industry to be reputable and safe. When people ask for something impossible, even us, he says, no.

• 9:30Speaker 01

  I would like to sleep better at night and have more energy during the day.

• 9:36Speaker 03

  Yeah, so you're not going to be able to make one product that puts you to sleep and then wakes you back up. We've had people try to do that.

• 9:43Speaker 01

  Really?

• 9:43Speaker 03

  We definitely got that request before.

• 9:46Speaker 01

  Frank says he also gets requests all the time to like jam pack supplements with so much of one ingredient that it becomes unsafe. And he will say no to that, too.

• 9:56Speaker 03

  You do have your bad actors where someone comes to us. We want to make this. And we say, well, that is not exactly possible. So they'll go to someone else and they'll say, hey, can you make this? Someone says yes. All of a sudden, it's in the market, but no one's checked what's really in it.

• 10:13Speaker 02

  Frank says a lot of people selling supplements came to this business because supplements are a good business. Often, the people who come to the industry used to sell some other, less profitable products.

• 10:25Speaker 03

  Yoga mats or, you know... Water bottles, anything that it might be, they wind up coming to supplements at some point because it's something people take every month and they reorder. Right? So it attracts entrepreneurs from different markets to say, hey, I can only sell this guy so many, you know,

• 10:45Speaker 01

  Water bottles and yoga mats.

• 10:46Speaker 03

  Right? Yeah, he's gonna use it once or twice. I can sell him the same green superfood powder every month and that customer lifetime value is gonna go way up.

• 10:55Speaker 01

  It's hard to say exactly why supplements are so popular right now.

• 10:59Speaker 02

  Frank told us that the supplement business really, really took off during COVID. In fact, supplement sales have increased around 50% since before the pandemic. There's also the wellness influencers on TikTok and Instagram. They've also contributed to the jump in sales.

• 11:14Speaker 01

  And then there's also just like a lot of distrust in institutions and the government and the pharmaceutical industry right now. And even though supplement makers are companies too, people feel like they're this more natural anti-establishment alternative.

• 11:29Speaker 02

  Even our own Health and Human Services Secretary, RFK Junior, he's a big fan of supplements. His acting FDA Commissioner wants to make them even easier to make and to sell.

• 11:40Speaker 01

  And there is a long history of people in the United States trying to test the limits of the free market and sell you some magic pill.

• 11:49Speaker 02

  One of my favorite stories is in the 1910s, there was this really popular supplement. It was claiming it could cure malnutrition using strychnine, which is in rap poison.

• 11:58Speaker 01

  Sounds lovely. In the 1920s and 30s, people were tinkering with yeast, trying to supercharge it with vitamins, claiming it would solve a bunch of things, including something called furry tongue, which is what it sounds like.

• 12:12Speaker 02

  And around that same time, a guy entranced with the power of radiation sold radioactive water as a cure for fatigue, which was popular until a New York tycoon's jaw fell off.

• 12:24Speaker 01

  His jaw? Fell off.

• 12:26Speaker 02

  Just disintegrated. Just completely disintegrated.

• 12:30Speaker 01

  By the 50s, doctors are calling all of this "medical quackery." Wonder why?

• 12:35Speaker 02

  But it was really hard to do anything about it.

• 12:38Speaker 01

  Yeah, the growth of the industry isn't just about how badly Americans want a magic pill. It's also thanks to years of lax regulations.

• 12:46Speaker 02

  Supplements have always been really hard to regulate. They're kind of a food because, you know, they're designed to supplement your diet. But they're also pills or gummies or powders. You know, they come in a jar with a label claiming to address your health problems. They feel like a drug. But drugs have to go through this really rigorous testing to prove that they work. Supplements do not. Supplements live in this weird no man's land.

• 13:16Speaker 01

  When the Food and Drug Administration was created in 1906, there was no mention of supplements. But over the years, the FDA has tried to regulate them many times, like in 1966. The FDA proposed a disclaimer be displayed in prominent type, like right there on the supplement bottle, basically saying that you can get your vitamins and minerals from the foods we eat and that there is no scientific basis for routine use of supplements.

• 13:44Speaker 02

  But people did not like that.

• 13:45Speaker 01

  They did not.

• 13:46Speaker 02

  And Congress got more than 2 million letters, which was actually more than they ever got during Watergate. So no disclaimers.

• 13:56Speaker 01

  Yeah, didn't go through. In the 70s, the FDA's official position was still that supplements are, quote, "nutritionally irrational."

• 14:05Speaker 02

  And that's like a giant government exclamation point.

• 14:08Speaker 01

  Yeah, but it didn't matter to anyone. Every time the FDA and Congress has tried to make supplement rules, the thing that got in the way was you, the consumer.

• 14:20Speaker 06

  Massive consumer backlash.

• 14:22Speaker 02

  This is Melanie Benish.

• 14:24Speaker 06

  The public really, really loves their supplements.

• 14:27Speaker 02

  Yeah. Melanie is a lawyer who focuses on food and drug regulations at the Environmental Working Group, which has for years advocated for safer consumer products and more regulation. She says the last time Congress even attempted to regulate supplements was in the early 90s. And the consumer revolt that followed basically killed any serious effort to regulate supplements ever again.

• 14:51Speaker 01

  That story starts in Kent, Washington. There was some alternative medicine clinic and the proprietor there was accused of illegally injecting patients with these high-dose concoctions of vitamins and minerals that the FDA repeatedly told them were unsafe.

• 15:09Speaker 02

  One day, FDA agents show up with the local police and kick down the door of the clinic. It makes the front page of the New York Times and the supplement industry sees this big newsy raid as an opportunity to fight back. They launch an incredibly effective counteroffensive.

• 15:28Speaker 01

  They got people to write thousands of letters to President George H.W. Bush, to Congress and the FDA, saying like, please, please, please, please, please do not touch our supplements. They even got health food stores to join in on the revolt.

• 15:40Speaker 06

  Health food stores put black curtains over the supplement aisle and the vitamin aisle and said, this is the future you're looking at if Congress gets its way.

• 15:51Speaker 02

  Some stores even refused to sell supplements on certain days to, you know, make people really live out the nightmare of this world without vitamins.

• 16:00Speaker 06

  They got Mel Gibson to do an ad.

• 16:03Speaker 01

  In the ad, you see a SWAT team kicking open the door of their SWAT van. They rush toward, I guess, Mel Gibson's mansion in full SWAT gear. They're scaling the side of the building. They get inside, night vision goggles, through the living room, guns drawn, and then they spot Mel Gibson.

• 16:20Speaker 03

  Freeze, drug enforcement.

• 16:22Speaker 06

  He's standing in his bathrobe and the FBI swoops in and knocks the vitamins out of his hands.

• 16:28Speaker 03

  Oh, oh, guys, hey, it's only vitamins. It's only vitamins.

• 16:32Speaker 01

  On the screen, it says, "Protect your right to use vitamins. Call Congress now."

• 16:40Speaker 03

  Vitamin C, you know, like in oranges?

• 16:43Speaker 01

  Congress gets an earful. And Congress gets the message. Supplements are kind of untouchable in the US.

• 16:50Speaker 02

  Technically, Congress did pass a big supplement law in 1994. It's called the Dietary Supplement Health and Education Act. But it is so lax that experts in this field don't even consider supplements to be regulated, almost at all.

• 17:04Speaker 01

  In fact, the law gave supplement makers more freedom, including something they'd always wanted: the legal right to claim on their labels that supplements were actually improving your health. And they could now claim this as long as they avoided a couple key words.

• 17:22Speaker 02

  OK, so a supplement maker cannot say their pill diagnoses, prevents, cures, treats, or mitigates a disease, like Alzheimer's. But they can say it helps improve your memory, which is a pretty subtle distinction.

• 17:39Speaker 06

  You know, it's not always clear to me what the difference is between, say, helping to maintain your blood sugar levels versus using it as part of a healthy diet to help maintain healthy blood sugar levels.

• 17:52Speaker 01

  Wait, is one of those OK and the other one is not OK?

• 17:55Speaker 06

  Yeah.

• 17:56Speaker 01

  They sound exactly the same.

• 17:57Speaker 06

  Yeah, so I have trouble distinguishing.

• 18:00Speaker 01

  This is the thing that the supplement maker, Frank, was kind of like guiding us on, right? He's like, "You can't say it burns fat. You gotta say it supports metabolism." So here's a little news you can use. Melanie says if the front of your supplement bottle says "supports X" or "promotes Y", that should be a signal to you that it is not actually proven to do anything. If you turn over your supplement bottle right now, you will even see in tiny, fine print that the claims on the bottle have, quote, "not been evaluated by the FDA."

• 18:33Speaker 02

  And sure, the supplement makers are supposed to have something to back up their claims, and there are a bunch of studies out there that say these things work. But you have to look at how good those studies are and who's funding them. There's a lot of conflict of interest there. There is nothing in the regulation that requires supplement makers to prove their product does what it says it does.

• 18:56Speaker 01

  So what's the point? What's the point of a supplement if it's not supposed to actually work on the thing it's claiming to work on?

• 19:02Speaker 06

  Hoops and dreams.

• 19:04Speaker 01

  The law also says you don't even have to prove your supplement is safe before you sell it to people, unless, there's one unless, unless it is a brand-new, never-before-used ingredient in a supplement. Then you do need to show some paperwork.

• 19:21Speaker 02

  Yeah, we have finally stumbled on an actual rule here. I'm excited. If your supplement includes a totally brand-new ingredient, that is one of the few times the company has to notify the FDA and show them their safety studies. Now, they don't have to prove that it's safe. This is supplement regulation, so that would be a wicked high standard. The law just requires that a supplement will, quote, "reasonably be expected to be safe."

• 19:53Speaker 01

  And if that doesn't make you feel super safe, then you should know that there is also a workaround to this rule. And there's one supplement, more than any other supplement, according to Melanie, that really exemplifies this fun workaround. How companies can get their supplements onto store shelves without proving that they're even reasonably expected to be safe. It involves glowing jellyfish.

• 20:18Speaker 02

  It all started with a young man from Wisconsin.

• 20:22Speaker 06

  Who, I think, had this epiphany and really homed in on jellyfish.

• 20:27Speaker 01

  Every good supplement starts with an epiphany. This was in the 90s. The young man was named Mark Underwood, and he had an idea for a new supplement that would improve memory. And the story goes that the idea came from this moment with his mom, who had MS, multiple sclerosis.

• 20:45Speaker 02

  And the details come from this really great article in Wired. We pulled it up in the studio with Melanie, and apparently, this guy's mom was always looking out for things that could help her. Since the disease had limited her body, Diane, the mother, says that she was attracted to the way jellyfish seemed to move so easily. And that's what led her to wonder if the marine animal might hold the key to a medical breakthrough.

• 21:09Speaker 01

  Diane, the mom, apparently tells her son about this.

• 21:12Speaker 02

  And he took to it like a dog with a bone.

• 21:15Speaker 01

  Hold on, hold on, hold on.

• 21:17Speaker 06

  So it wasn't even about memory? Why did we think that jellyfish have good memory?

• 21:21Speaker 01

  Don't they famously not have brains?

• 21:23Speaker 02

  Yeah, exactly. They don't have brains. But despite jellyfish not having brains.

• 21:28Speaker 01

  Or hearts.

• 21:29Speaker 02

  Or hearts. Mark wants to make his memory-boosting jellyfish supplement anyway.

• 21:35Speaker 01

  Yeah, and he's not going to use jellyfish from the ocean for this, OK? He wants to use something that mimics the protein found in glowing jellyfish.

• 21:45Speaker 02

  Because they have to be glowing.

• 21:47Speaker 01

  So this is a synthetic, made-in-a-lab version of the protein that causes jellyfish to glow, OK? And he sets out to now sell that product. And on his marketing material, he promises his supplement will, quote, "not cause any glowing." Wow. So it will not make you glow, but it will apparently improve your memory.

• 22:11Speaker 02

  So what does it take for him to get that into stores or sell it online?

• 22:15Speaker 01

  Well, the jellyfish company first went to the FDA, but the FDA was like, "Yeah, no, it doesn't meet our safety threshold," which is honestly a pretty low threshold.

• 22:27Speaker 02

  And when the company ran it by the FDA again a few years later, FDA says, nope, we still don't think it's safe enough.

• 22:33Speaker 01

  But there is a way around that pesky little FDA objection. There is a law from the food regulation world that supplement makers can take advantage of.

• 22:44Speaker 02

  Uh huh.

• 22:45Speaker 01

  If you've heard our recent story on how untested chemicals sneak into our food, this might sound familiar, but if you are a food maker and you've just invented a new chemical or a new ingredient that has never been used in food before, you can just declare that your own brand new ingredient is safe, that it's generally recognized as safe, or GRAS, G-R-A-S.

• 23:07Speaker 02

  So if you're having trouble getting your new supplement ingredient, like glowy jellyfish stuff, past the FDA's review process, Melanie says you can just put it in a food product first.

• 23:17Speaker 06

  So put it in a protein shake or something else. And then now it's part of the food supply.

• 23:22Speaker 01

  Hold on. Melanie pointed to a supplement trade article that says industry lawyers even advise their clients to do this. Like, you can skip that pesky FDA hurdle. Just put your new ingredient in a food product first. And now you can add it to your brand new supplement as a generally recognized as safe product. Ta-da. And that is exactly what the glowy jellyfish guy did.

• 23:50Speaker 06

  They said, aha, we'll put it in food. And that was the birth of the Prevagen shake.

• 23:58Speaker 02

  The Prevagen shake. They called it Neuroshake. And the jellyfish company did formally notify the FDA. They were now introducing the jellyfish thing as a food ingredient. The FDA again questioned the safety of the ingredient in the shake. But once you're talking about food ingredients, companies can actually ignore the FDA's concerns, as long as they self-certify that their ingredient is safe.

• 24:24Speaker 01

  Yeah, that safety self-certification allows them to bypass the FDA's review process. So the jellyfish company self-certified that their synthetic, lab-made jellyfish stuff was safe to drink in a shake, totally legal, because we're talking about food products now.

• 24:41Speaker 02

  And once they got into food, that gave them the right to add it to the supplement. That is the get around.

• 24:47Speaker 01

  That is how we have this synthetic jellyfish shake and the synthetic jellyfish pill. And actually, the pill was on the market the whole time. No one stopped them through all the back and forth with the FDA expressing concerns and all of that. They were just selling it anyway.

• 25:03Speaker 02

  Between 2007 and 2015, the jellyfish company racked up more than $165 million in sales. Meanwhile, people were reporting side effects to the company, that they were having chest pain and seizures and strokes while taking this supplement. But unless the FDA is aware of an imminent hazard or they do their own testing and can prove that a supplement is unsafe, which takes years and lots of money, the FDA can't take a product off the market. But the Federal Trade Commission can bring a case against them for false advertising.

• 25:42Speaker 01

  And the FTC did that with the jellyfish supplement. They sued in 2017. And just a short, almost eight years later, the FTC won its case. The company was claiming that their product was clinically proven to improve memory. And the FTC said, um, there's one clinical trial and it did not show their supplement improved memory. So now the label just says, Prevagen, for your brain. Nice. They promise there.

• 26:12Speaker 02

  But people are still buying it. It's currently in the top five of Amazon's list of blended vitamin and mineral supplements.

• 26:20Speaker 01

  And listen, maybe synthetic, lab-made glowy fish stuff is one thing, right? Like, maybe that feels totally different from, say, fish oil or collagen or herbal supplements, like turmeric pills. But Melanie says even the ones that seem all natural or super familiar may not be what you think.

• 26:43Speaker 02

  Take green tea supplements.

• 26:46Speaker 02

  That sounds like a thing that just grows in nature, but the green tea in your supplement is rarely the actual leaves that you see in your tea bag.

• 26:54Speaker 01

  It's an extract made by bathing the tea leaves in a solvent, usually ethanol, to extract a particular antioxidant called EGCG, which is all the rage among influencers. But high concentrations of lab-processed green tea EGCG extract is linked to acute liver damage and sometimes death.

• 27:14Speaker 02

  Or turmeric supplements. They often contain 10 times the amount recommended by the World Health Organization. After the break, we're talking about the regular, everyday, familiar herbal supplements and vitamins that so many of us have in our kitchens right now.

• 27:30Speaker 01

  Yeah, you're probably not going to want to hear this next part.

• 27:45Speaker 00

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• 28:29Speaker 04

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• 29:01Speaker 01

  So I have these like gummies, vitamin C, adult gummies C is what they're called. And why are you taking that? It's like a little treat, you know, it's like, it's like a gummy bear, except maybe there's some vitamin C in there. Ah, and you feel like you're making yourself healthy. This is Marion Nessel. If you're vitamin C deficient, it could be quite useful. I don't know anybody who's vitamin C deficient if they eat any fruits and vegetables at all. I mean, scurvy is not a major problem in the United States. It's not a public health problem. Yeah.

• 29:38Speaker 02

  Marion is basically a legend in the food, nutrition, supplement world. She has a background in molecular biology, has written 17 books on the politics of food and supplements, and has been a public health advocate for decades.

• 29:52Speaker 01

  I'm 89. 89. Good nutrition. Good nutrition, is that what you? So there's nothing really bad you buy? I buy tortilla chips, I buy ice cream, I buy all kinds of things. I eat my share of junk food. But vitamins, supplements, do you take any? No. No vitamin D? Vitamin D is not a vitamin, it's a hormone that you get from exposure to the sun. Sick burn Marion. Sorry. So, yeah, no vitamin supplements for this true legend. I wouldn't take it because I don't know what's in those packages. What it says on the label is not what's in the package.

• 30:35Speaker 02

  For Marion, it's not just that supplements are unregulated when it comes to the safety of their ingredients, she's worried about an even more basic problem. Like what even are the ingredients?

• 30:48Speaker 01

  Your turmeric supplement may or may not have turmeric in it. What, don't you check the ingredient list and say, does it say turmeric as an ingredient? It doesn't matter. It doesn't have to have in it what it says on it.

• 31:01Speaker 02

  Technically, supplements are supposed to contain what they say they do, but?

• 31:05Speaker 01

  Nobody has the resources to check and see whether those supplements have in them. What it says on the label unless somebody sues the company. If there's no lawsuit involved, there's nobody minding the store. Is that, is it the same way with food? Like if you read an ingredient in a food product. No, no, no, no, no, that will be accurate.

• 31:28Speaker 02

  Yeah, because the FDA will sometimes spot check food ingredients to make sure they're for real.

• 31:34Speaker 01

  But on a supplement. You have no way of knowing.

• 31:36Speaker 02

  And, and sometimes supplements have stuff in there that really shouldn't be in there.

• 31:44Speaker 01

  Lead, arsenic, or other heavy metals. There is a private supplement testing lab called Consumer Lab that Marion points to a lot. Its whole business is testing supplements to see what is actually in them. And recently, they tested a bunch of turmeric pills on the market and found that one had no turmeric, basically, and others had more than even advertised.

• 32:08Speaker 02

  And they have found similar variations in echinacea supplements and elderberry supplements. Consumer Labs found that more than two thirds of elderberry supplements sold on Amazon did not contain authentic elderberry at all.

• 32:20Speaker 01

  This is true of every supplement. Well, maybe not every, but. I can't think of a single supplement that Consumer Lab has investigated where it hasn't found wide variation.

• 32:34Speaker 02

  According to a 2017 study, 20% of liver toxicity cases were tied to herbal and dietary supplements.

• 32:41Speaker 01

  Over most of the last 30 years, supplement-related liver failure increased eightfold, so much so that people started having to be put on wait lists for liver transplants. Now, that might be because of user error, like people taking a bunch of these supplements in a day, thinking more must be better, but maybe it's other reasons. It's really hard to pinpoint.

• 33:02Speaker 02

  Marian says there are some supplements on the shelves that are maybe more trustworthy than others. If they're marked with an NSF or USP, that indicates that they've been third-party tested, that the supplements do contain the ingredients listed, and that the amounts are accurate and not at harmful levels. Remember Frank, our supplement maker? His supplements are NSF certified.

• 33:27Speaker 01

  And Marian thinks it is pretty important to point out that most supplements, whether they are certified or not, likely are not causing any real harm, even if they likely aren't causing any benefit. Some of them are harmful, and that's a problem. But most of them are not particularly harmful. So there's a little risk, but it's not a big risk.

• 33:49Speaker 02

  I mean, to be honest, that kind of surprised me. I mean, Marian Nessel, woman of science, you would think would be rabidly anti-supplement. Honestly, she's kind of like, do whatever you want, people.

• 34:02Speaker 01

  You know, this is like religion. You don't argue with people about religion. There's no evidence that they make healthy people healthier. But if people believe that these things are doing them good, I'm not going to argue with that. There's nothing I can say to dissuade them. And I'm not even going to try.

• 34:22Speaker 02

  Marian wrote the history on this. She knows that even when people see the science, it rarely makes them throw out their supplements.

• 34:30Speaker 01

  I must admit, I have not thrown out my vitamin C gummies or my turmeric pills. Though, I don't know, Jane, maybe I just won't buy them again.

• 34:39Speaker 02

  Yeah, we were surprised that some of the experts we talked to, experts who advocate for supplement regulation and are well aware of all of these problems, they still take some supplements, too.

• 34:52Speaker 01

  Maybe it's totally irrational of us, but maybe it's not. Because there is one good thing that supplements do sometimes do for us, says Marian. Supplements make people feel better. There's Absolutely no question about that. Did she just say supplements make people feel better?

• 35:13Speaker 02

  Yeah, but it's not necessarily because their ingredients actually do what they say they'll do.

• 35:20Speaker 01

  Yeah, it's this other thing. It has a fabulous placebo effect. Yeah, you feel like your vitamin C gummy helps you not catch a cold and then you don't catch a cold. Placebos, baby.

• 35:32Speaker 02

  Magic.

• 35:34Speaker 01

  There's plenty of evidence that supplements are fabulous placebos. And in fact, I can tell you a story about a study that proved that. But it doesn't matter. Life is really hard these days. And if all it takes is a supplement pill to make people feel better, I'm, you know, I'm not going to argue too much about it.

• 35:58Speaker 02

  I love placebos.

• 35:59Speaker 01

  Yeah, I do, too.

• 35:59Speaker 02

  They're so powerful.

• 36:00Speaker 01

  I do, too. I do, too. So if you're going to buy supplements, you buy from the most reputable company you can find. And keep your fingers crossed. Just cross your fingers, Jane.

• 36:11Speaker 02

  Thank you so much, Mary Ann. I'm feeling, feeling good about this. Feeling really good.

• 36:16Speaker 01

  You know what gets me about all this, Jane? If supplement makers were to just be like fully transparent, right? They put on the bottle, there might not be that much turmeric in here and it may cause liver damage. And it may not even be anti-inflammatory, like we're suggesting. I don't even think that would stop people from buying them.

• 36:34Speaker 02

  Yeah, probably not. I mean, we've got 100 years of history that says nothing is going to come between Americans and their supplements.

• 36:43Speaker 01

  But you don't even take supplements, Jane.

• 36:45Speaker 02

  Right, I know. I mean, nothing's going to come between you and your supplement.

• 36:47Speaker 01

  Yeah, right. This episode was produced by Sam Yellowhorse Kessler, takes fish oil, edited by Mary Ann McCune, daily multivitamin, and fact-checked by Sierra Juarez with help from Vito Emanuel, who do not take any supplements because, of course, our fact-checkers don't. It was engineered by Robert Rodriguez with help from Jimmy Keeley. And Alex Goldmark is our executive producer.

• 37:09Speaker 02

  Special thanks to Jensen Jones at the Center for Science in the Public Interest, and Kiara Eisner, who wrote that great Wired article and now works for NPR.

• 37:18Speaker 01

  Woo, woo, woo. I'm Sarah Gonzalez.

• 37:21Speaker 02

  And I'm Jane Black. This is NPR. Thanks for listening.

• 37:33Speaker 04

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• 38:08Speaker 02

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