The hidden health hazards in workout supplements

Dr Simon Hendel | Jan 19 2017Finally – it’s sun’s out, guns out season.

But with more and more men striving for that perfectly shredded beach bod, many are resorting to supplements to achieve it. But while mates might not let you forget leg days, real friends remind to find out whether the supplements you’re using are actually safe.

The industry is completely unregulated

Sports and exercise physician, Dr Krishant Naidu has had patients ask him for everything from caffeine to human growth hormone and anabolic steroids as they strive to get bigger.

You may think over-the-counter supplements are far less dangerous than anabolic steroids, but Dr Naidu says the real problem is the total lack of industry regulation. To put it simply, the powder you mix for a pre-workout boost or an after-workout bulk-up isn’t necessarily what it says it is.

“Unlike pharmaceuticals, there’s no requirement for manufacturers to prove the safety of the supplements they sell,” he says. “Or even guarantee what’s in them.”

The great supplement heist

International manufacturers can have components mixed together in some chemical factory offshore and then send this to another factory for branding as an appealing wild-berry-flavoured workout product. And if you order these online they won’t go through any testing in Australia before you consume them.

On the other hand, supplements made in Australia are subject to “batch-testing” which means the risk of contamination is low and they’re likely to contain what they claim – making Australian products much safer to use, says Dr Naidu.

So if you are keen on taking some kind of supplement, either pre- or post-workout, at the very least go Australian made.

Even ones that work may cause health problems

Creatine is marketed to improve performance and there’s some evidence supporting its effectiveness. Although Dr Naidu stresses the research looking at creatine is limited.

And its use can cause serious kidney damage even in people with healthy kidneys – especially if you’re dehydrated.

Supplements containing protein and carbohydrate are commonly marketed to gym-goers to increase their energy and improve recovery.

Dr Naidu says there’s good quality evidence that taking carbohydrates and protein together, in the first 30 minutes after a workout, will provide the best conditions for muscle gain.

But, he says, there isn’t any compelling evidence that carbohydrates and protein from supplements are any more effective than from a good diet.

Secret stimulants

Still other supplements that claim to help “shredding” often contain stimulants not listed in the ingredients to aid weight loss, says Dr Naidu. And these are usually derivatives of the drug ephedrine that can place the heart under considerable stress – even if they do work to drive weight loss and improve muscle definition.

A dangerous addiction

Former gym devotee, Mina, 35, who doesn’t want his surname published, knows first hand the risks of using supplements.

His fitness motivation morphed from being healthy and fit to being driven by image, one where bigger was better.

Mina was using so many stimulant-based supplements that he needed ever-increasing doses for the same effect. He recalls regularly having to pull over on the way to the gym after taking pre-workout “supps” because he had tremors and heart palpitations.

“The older formulations were incredibly dangerous,” he says.

Focus on the real issues

Mina’s use of supplements and other aids was also a money pit. At his peak, he says he was spending more than $600 a fortnight – not including gym memberships.

He’s now completely off it all and says “not a single minute” was worth it.

Dr Naidu’s message to anyone considering adding in supplements as a boost to reach their end goal is simple: focus on your health, not your looks.

 

A Supplement Maker Tried to Silence This Harvard Doctor—and Put Academic Freedom on Trial

When Pieter Cohen published findings of illegal and potentially dangerous ingredients in weight loss pills, the company sued him. The trial was high stakes.

The dietary supplements had ominous names, like Black Widow and Yellow Scorpion. They contained an illegal and potentially dangerous molecule, similar in structure to amphetamines.

But when a Harvard researcher dared to point that out, in a scientific, peer-reviewed study and in media interviews, the supplement maker sued him for libel and slander.

STAT has conducted the first detailed look at the legal showdown that followed by interviewing key players and reviewing hundreds of pages of trial transcripts and other court documents. The jury trial had momentous implications for the future of research into the safety of weight-loss and muscle-building pills; for the freedom of academics to speak out about matters of public health; and for our ability to learn what’s in the supplements on our kitchen counters.

In case things weren’t interesting enough, swirling in the backdrop was a bizarre backstory involving a slew of sensational allegations against the wealthy founder of the supplement company – who dreamed up the business while in prison on a charge stemming from selling ecstasy.

The Harvard researcher, Dr. Pieter Cohen, won the defamation trial in federal court in Massachusetts in November.

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But the man who sued him, Jared Wheat, the owner and CEO of Hi-Tech Pharmaceuticals, doesn’t see the jury verdict as a loss: He’s openly hopeful that the long and costly legal battle will scare away other academics from investigating the supplement industry.

If that doesn’t work, he’s counting on President-elect Donald Trump to follow through on vows to to “open up” the nation’s libel laws to make it easier for parties who feel they have been defamed to win lawsuits. Trump has discussed this goal in the context of his grievances against the news media. But it could also have ramifications for published research.

Asked whether Trump should make easing libel laws a priority, Wheat told STAT: “Absolutely.”

Meanwhile, the six adulterated supplement brands from Hi-Tech are still on the market, despite alarms raised not just by Cohen, but by the Food and Drug Administration. The FDA has ordered Hi-Tech to recall several such products. Wheat has refused, though he said the company has voluntarily made minor tweaks to the formulas for some of them to satisfy distributors.

The entire episode opens a window into the Wild West world of supplements. Unlike drug companies, supplement manufacturers don’t have to show that their formulations are safe or effective before putting a product on the market. They don’t have to run clinical trials. They don’t have to consult federal regulators.

With little oversight, they can jump right into a highly lucrative industry: Wheat, a convicted felon, said his company brings in more than $100 million a year in annual revenue. His company’s social media pages are lined with images of bodybuilders with veins bursting out of their biceps.

 And Wheat has no regrets about spending what he estimated as between $300,000 and $400,000 in corporate funds to go after an academic who challenged the safety of his products in a meticulously documented study.

“I spent a lot of money, but hopefully it will deter others from going out there and making baseless allegations,” Wheat said in a phone interview from his company’s headquarters in Georgia. His advice to other academics: “Think twice and do better research, knowing you can get sued if you do this.”

A hidden danger in weight-loss pills

Pieter Cohen was browsing an email newsletter when he learned he was being sued for $200 million.

Sitting at his computer that day in the spring of 2015, he stumbled upon a report of the lawsuit in a supplement industry trade publication. He wasn’t even sure at first if it was real.

It was. Hi-Tech was suing him and his three coauthors in federal court in Georgia over the study they had published a few weeks earlier in the scientific journal Drug Testing and Analysis.

Cohen had launched that study with the goal of prodding the FDA to enforce the law by cracking down on supplements illegally containing a compound known as BMPEA. Chemically similar to amphetamines, BMPEA has never been demonstrated to be safe or effective in humans.

And there are plenty of reasons to suspect it can be dangerous. It’s been shown to send blood pressure and heart rate soaring in dogs and cats. It’s been linked to a stroke in a Swedish woman. Such evidence prompted Canadian health officials to call it a “serious health risk.”

Supplement makers often claim that BMPEA is a natural botanical product that comes from a Southwestern shrub called Acacia rigidula. In fact, it has never been shown scientifically to come from that shrub, or from any other natural source. And the shrub itself is illegal to include in supplements because no manufacturer has gone through the necessary steps to prove that it’s safe for humans to ingest.

There are a number of theoretical reasons that companies might want BMPEA in their products. It’s possible that it might have weight-loss effects similar to those of amphetamines, which decrease appetite and increase metabolism. It may also aid in athletic performance. In other words: BMPEA might be more potent than natural botanical ingredients.

In 2014, FDA scientists had reported detecting BMPEA in a handful of supplement products labeled as containing Acacia rigidula – but they couldn’t find any evidence of BMPEA in the actual shrub. That research made a minor splash, but the FDA team hadn’t named names.

Cohen – who’s known as perhaps the most dogged detective scrutinizing supplements – wanted to see if he could replicate some of those findings and publicize the specific brands containing BMPEA.

So his team chemically analyzed 21 popular supplements, made by a handful of manufacturers and labeled as containing Acacia rigidula. Eleven of them turned out to contain BMPEA – including six of the 10 Hi-Tech products in the study. (All six were marketed for weight loss.)

Hi-Tech’s “Fastin-XR” pills, for example, contained 82 milligrams of BMPEA in the maximum daily dose recommended on the label. The maximum recommended dosage of “Yellow Scorpion” pills contained 69 milligrams, and “Black Widow,” 56 milligrams. Because BMPEA has not been studied in humans, it’s hard to compare the strength of these pills to, say, ADHD medication, but it was clear this was more than a trace.

Such pieces of evidence “strongly suggest” that BMPEA is synthetically produced and used to spike the products, Cohen’s paper concluded.

The study immediately made waves: Cohen went on “Good Morning America” and was quoted in an article that appeared on the front page of some editions of the New York Times. Two senators issued a stern statement urging the FDA to keep such products off the shelves.

And within two weeks, the FDA issued warning letters to Hi-Tech and four other companies, ordering them to recall products containing BMPEA.

Cohen’s study listed products and their manufacturers in the table of results. That’s the only place in the paper where Hi-Tech is named. Cohen did not mention Hi-Tech by name in any of his media interviews.

Still, all the attention was giving Hi-Tech’s customers cold feet. Distributors and retailers, including Rite Aid, sent back Hi-Tech products. A few other supplement companies that paid Hi-Tech to manufacture their products took their business elsewhere. So Wheat sued. He would later blame Cohen for costing Hi-Tech an immediate $14 million in lost business.

News about the suit spread quickly in the dietary supplement industry. Wheat said he got “hundreds” of supportive calls and emails from people “hoping that we were able to silence this guy.”

A watchdog becomes a target

The guy the supplement industry wants to silence speaks thoughtfully, punctuating his points with emphatic hand gestures. Cohen is friendly and informal, at one point rolling up his pant leg to show a large skin graft on his left calf, a battle scar from a fall during a hiking expedition with his wife and their three school-aged children.

“He’s the kind of person you want as your doctor,” said Dr. Joshua Sharfstein, a former principal deputy FDA commissioner and now a professor of public health at Johns Hopkins. “He’s not a clock-puncher by any stretch of the imagination.”

Cohen, 46, is an assistant professor at Harvard Medical School and an internist at Cambridge Health Alliance, a network of hospitals and clinics just north of Boston. He first got interested in studying supplements after seeing Brazilian immigrant patients with alarming symptoms, such as palpitations, panic attacks, and even kidney failure. It turned out they had been taking a Brazilian weight-loss supplement spiked with amphetamines, antidepressants, and benzodiazepines.

With hardly any research funding, Cohen has turned out study after high-impact study identifying hidden synthetic stimulants in popular weight-loss products. And he’s repeatedly called for tighter regulation. He’s become the most widely recognized critic of the supplement industry, in part because he’s very media-savvy, boosting the reach of his studies by pitching them to journalists. (He also pitched STAT on writing about this lawsuit.)

Cohen’s well-regarded even among some people who disagree with him. Steve Mister, president of the Council for Responsible Nutrition, a trade group for dietary supplement makers, praised him for performing an “important watchdog function” and added that he does “some very good research” – even though Mister generally doesn’t think it should translate to policy changes. (Hi-Tech has never been a member of the trade group.)

Cohen had dealt with supplement companies unhappy with his research before, but it had never gone anywhere. And Hi-Tech’s suit seemed destined for the same fate last spring when a judge in Georgia dismissed it because Cohen didn’t do any of his work there.

But then Hi-Tech refiled in Massachusetts, with a few small changes. Cohen’s coauthors were no longer named as defendants. The demand for precisely $200 million in damages was dropped, too.

And this time, Cohen’s Harvard lawyers couldn’t get the suit dismissed. Last summer, a federal judge ruled that the company had a 7th Amendment right to a jury trial.

Academics around the country have come under similar threats, said Hank Greely, a law professor who heads the Center for Law and the Biosciences at Stanford University.

“Some threats come through litigation, some of them come through legislative requests or demands, and we don’t really have any good ways of dealing with them,” Greely said. “There are lots of ways that scientists are getting harassed.”

And faculty members can’t always count on their university to provide legal assistance; it depends on a number of factors, including the kind of research they’re doing, according to Robert O’Neil, former general counsel for the American Association of University Professors.

Cohen was lucky to have Harvard in his corner. Still, the several months leading up to the trial were grueling for him. He had to put aside all his research projects. He was deposed for an intense six and a half hours. And he worried about the financial hit he could take, should the jury decide against him. It took months for Harvard’s insurer to commit to covering a jury award for Hi-Tech, and even then it would only cover up to $5 million. The trial started out with Hi-Tech demanding more, though by the end, the company’s demands were whittled to below $5 million.

Worst of all, Cohen was required to turn over hundreds of pages of his notes, peer-review feedback, and his written correspondences with the journal, coauthors, and journalists.

“That’s when I really just had a new sense of what we were talking about here,” Cohen said.

An antagonist with a checkered past

The seven-day trial, which started last October, wasn’t about whether Hi-Tech’s supplements actually contained BMPEA.

Hi-Tech admitted they did in the initial lawsuit – in fact, a few of the products in question actually listed it on their labels – but claimed, without evidence, that it had naturally extracted the substance from Acacia rigidula.

Instead, the case hinged on what Cohen had said about BMPEA: Had it really never been tested for safety or efficacy in humans? Was it really potentially dangerous? Was it really synthetic, not derived from Acadia rigidula?

These are not controversial questions in the scientific community. (The answers are yes, yes, and yes.) But they are scientifically complex questions, and it was far from certain how the jury would assess the evidence.

Hi-Tech’s lawyers and witnesses claimed, without evidence, that BMPEA had been evaluated in proprietary studies that have never been published. They also tried to persuade the jury that the compound had been tested by pointing to studies of molecules that are chemically similar to, but ultimately distinct from, BMPEA.

By contrast, Cohen’s lawyer, Brian Sullivan, focused on the high stakes for public health. In his opening statement, Sullivan urged the jury to consider the evidence “in the context of Dr. Cohen’s ability and his right to speak the truth to powerful interests and the interests of his patients and people in general … [who are] putting things in their bodies without knowing really what’s in there.”

The trial and its preparations also aired unsavory details about Hi-Tech’s checkered past.

First convicted for selling ecstasy while still a teenager, Wheat went on to violate the terms of his release and spent several years in prison, where he conceived of Hi-Tech.

The business was rolling by 1998, but Wheat didn’t stay out of trouble for long. In 2003, the FDA forced his company to destroy supplements spiked with an unapproved erectile dysfunction drug. In 2006, the agency seized $3 million worth of his company’s products containing ephedra, a banned and potentially dangerous stimulant.

Later that year, Wheat and several Hi-Tech associates were arrested for running an illegal online pharmacy based out of Belize. Federal prosecutors later alleged that Wheat had been involved in discussions about killing an FDA agent and blackmailing a federal prosecutor.

Wheat denied knowledge of these alleged and unrealized schemes, and the government didn’t pursue them. He pleaded guilty to the illegal pharmacy charge and was sentenced to four years in prison. (He did another two-month stint behind bars in 2014 for not complying with a court order to recall Hi-Tech products.)

Asked about the conviction, Wheat said, “it would take hours to explain, and I just don’t have time to deal with it, and nobody ever tells the accurate side of the story.” He also told this reporter to “go write your slander piece all you care to – that’s what all y’all do.”

In his opening statement, Sullivan framed Hi-Tech’s clashes with the law as important context for the jury to consider.

Hi-Tech’s lawyer, by contrast, made a point in his closing statement to note that the company had “rebuilt [its] reputation” after “coming back from those setbacks.”

The trial was tough on Cohen. At one point, he had to rush to the emergency room when the lymphatic system in his leg got infected, stemming from the hiking injury. And he knew that his own research career – and the whole field of independent research into the safety of supplements – hung in the balance. After all, if Hi-Tech could successfully sue over research it didn’t like, what would stop other companies from trying the same?

In his closing statement to the jury, Sullivan turned to a quote often (perhaps erroneously) attributed to Winston Churchill. “‘You have enemies? Good. That means you stood up for something in your life.’ Dr. Cohen has enemies because he stood up sometimes in his life,” he declared.

Two and a half hours after they left to deliberate, the jurors returned a verdict in Cohen’s favor.

Cohen was still too wound up to feel anything. It wasn’t until a few days later, when it dawned on him that the trial was really, finally, over, that he felt relief.

Then he got back to work.

More research is on the way

Wheat explains away his loss in part by pointing to the makeup of the Massachusetts jury pool: They probably had a hometown bias for a local university professor – not to mention the fact that “they’re liberal people up there,” Wheat said. He insists he would have won had the trial been in Georgia, where the company is based.

Meanwhile, consumers are still buying the supplements in question. Wheat claimed his company altered several of them by slightly tweaking the chemical structure of BMPEA to satisfy distributors who refused to carry the products otherwise. He likened it to making green tea decaffeinated.

He insists those changes didn’t come in response to the FDA’s April 2015 warning to recall several products containing BMPEA. FDA spokesperson Lyndsay Meyer said the agency is “continuing to work with each of the companies [warned about BMPEA] to ensure that their products comply with federal law.”

But Wheat characterized those letters as toothless – an attitude that exposes the FDA’s limited ability to police potentially unsafe supplements.

After Wheat lost the suit against Cohen, he said, “a few dozen” people in the industry called to say they hoped it had at least “deterred” Cohen from actively publicizing his critical research.

They might be unwise to count on it.

Cohen submitted a new study for publication just days after he won his trial, and has three new projects in motion in the new year. He believes it will be more important than ever under the new Trump administration to hold the FDA responsible for enforcing the law.

“My experience,” Cohen said, “has really reinforced to me why it is so important to not only continue the research we’re doing but to be very aggressive about speaking out about it.”

He said he hopes his experience will spur discussion about legal protections for academic researchers. “How many people can continue in the field if this is what it takes,” he said. “If one paper leads to this?”

 

 

[Original Article]

The Vitamin Myth: Why We Think We Need Supplements

[Original Article]

Nutrition experts contend that all we need is what’s typically found in a routine diet. Industry representatives, backed by a fascinating history, argue that foods don’t contain enough, and we need supplements. Fortunately, many excellent studies have now resolved the issue.

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slipah/Flickr

On October 10, 2011, researchers from the University of Minnesota found that women who took supplemental multivitamins died at rates higher than those who didn’t. Two days later, researchers from the Cleveland Clinic found that men who took vitamin E had an increased risk of prostate cancer. “It’s been a tough week for vitamins,” said Carrie Gann of ABC News.

These findings weren’t new. Seven previous studies had already shown that vitamins increased the risk of cancer and heart disease and shortened lives. Still, in 2012, more than half of all Americans took some form of vitamin supplements. What few people realize, however, is that their fascination with vitamins can be traced back to one man. A man who was so spectacularly right that he won two Nobel Prizes and so spectacularly wrong that he was arguably the world’s greatest quack.

In 1931, Linus Pauling published a paper in the Journal of the American Chemical Society titled “The Nature of the Chemical Bond.” Before publication, chemists knew of two types of chemical bonds: ionic, where one atom gives up an electron to another; and covalent, where atoms share electrons. Pauling argued that it wasn’t that simple — electron sharing was somewhere between ionic and covalent. Pauling’s idea revolutionized the field, marrying quantum physics with chemistry. His concept was so revolutionary in fact that when the journal editor received the manuscript, he couldn’t find anyone qualified to review it. When Albert Einstein was asked what he thought of Pauling’s work, he shrugged his shoulders. “It was too complicated for me,” he said.

For this single paper, Pauling received the Langmuir Prize as the most outstanding young chemist in the United States, became the youngest person elected to the National Academy of Sciences, was made a full professor at Caltech, and won the Nobel Prize in Chemistry. He was 30 years old.

In 1949, Pauling published a paper in Science titled “Sickle Cell Anemia, a Molecular Disease.” At the time, scientists knew that hemoglobin (the protein in blood that transports oxygen) crystallized in the veins of people with sickle-cell anemia, causing joint pain, blood clots, and death. But they didn’t know why. Pauling was the first to show that sickle hemoglobin had a slightly different electrical charge — a quality that dramatically affected how the hemoglobin reacted with oxygen. His finding gave birth to the field of molecular biology.

In 1951, Pauling published a paper in the Proceedings of the National Academy of Sciences titled “The Structure of Proteins.” Scientists knew that proteins were composed of a series of amino acids. Pauling proposed that proteins also had a secondary structure determined by how they folded upon themselves. He called one configuration the alpha helix — later used by James Watson and Francis Crick to explain the structure of DNA.

In 1961, Pauling collected blood from gorillas, chimpanzees, and monkeys at the San Diego Zoo. He wanted to see whether mutations in hemoglobin could be used as a kind of evolutionary clock. Pauling showed that humans had diverged from gorillas about 11 million years ago, much earlier than scientists had suspected. A colleague later remarked, “At one stroke he united the fields of paleontology, evolutionary biology, and molecular biology.”

Pauling’s accomplishments weren’t limited to science. Beginning in the 1950s — and for the next forty years — he was the world’s most recognized peace activist. Pauling opposed the internment of Japanese Americans during World War II, declined Robert Oppenheimer’s offer to work on the Manhattan Project, stood up to Senator Joseph McCarthy by refusing a loyalty oath, opposed nuclear proliferation, publicly debated nuclear-arms hawks like Edward Teller, forced the government to admit that nuclear explosions could damage human genes, convinced other Nobel Prize winners to oppose the Vietnam War, and wrote the best-selling book No More War! Pauling’s efforts led to the Nuclear Test Ban Treaty. In 1962, he won the Nobel Peace Prize — the first person ever to win two unshared Nobel Prizes.

In addition to his election to the National Academy of Sciences, two Nobel Prizes, the National Medal of Science, and the Medal for Merit (which was awarded by the president of the United States), Pauling received honorary degrees from Cambridge University, the University of London, and the University of Paris. In 1961, he appeared on the cover of Time magazine’s Men of the Year issue, hailed as one of the greatest scientists who had ever lived.

Then all the rigor, hard work, and hard thinking that had made Linus Pauling a legend disappeared. In the words of a colleague, his “fall was as great as any classic tragedy.”

The turning point came in March 1966, when Pauling was 65 years old. He had just received the Carl Neuberg Medal. “During a talk in New York City,” recalled Pauling, “I mentioned how much pleasure I took in reading about the discoveries made by scientists in their various investigations of the nature of the world, and stated that I hoped I could live another twenty-five years in order to continue to have this pleasure. On my return to California I received a letter from a biochemist, Irwin Stone, who had been at the talk. He wrote that if I followed his recommendation of taking 3,000 milligrams of vitamin C, I would live not only 25 years longer, but probably more.” Stone, who referred to himself as Dr. Stone, had spent two years studying chemistry in college. Later, he received an honorary degree from the Los Angeles College of Chiropractic and a “PhD” from Donsbach University, a non-accredited correspondence school in Southern California.

Pauling followed Stone’s advice. “I began to feel livelier and healthier,” he said. “In particular, the severe colds I had suffered several times a year all my life no longer occurred. After a few years, I increased my intake of vitamin C to ten times, then twenty times, and then three hundred times the RDA: now 18,000 milligrams per day.”

From that day forward, people would remember Linus Pauling for one thing: vitamin C.

In 1970, Pauling published Vitamin C and the Common Cold, urging the public to take 3,000 milligrams of vitamin C every day (about 50 times the recommended daily allowance). Pauling believed that the common cold would soon be a historical footnote. “It will take decades to eradicate the common cold completely,” he wrote, “but it can, I believe, be controlled entirely in the United States and some other countries within a few years. I look forward to witnessing this step toward a better world.” Pauling’s book became an instant best seller. Paperback versions were printed in 1971 and 1973, and an expanded edition titled Vitamin C, the Common Cold and the Flu, published three years later, promised to ward off a predicted swine flu pandemic. Sales of vitamin C doubled, tripled, and quadrupled. Drugstores couldn’t keep up with demand. By the mid-1970s, 50 million Americans were following Pauling’s advice. Vitamin manufacturers called it “the Linus Pauling effect.”

Scientists weren’t as enthusiastic. On December 14, 1942, about thirty years before Pauling published his first book, Donald Cowan, Harold Diehl, and Abe Baker, from the University of Minnesota, published a paper in the Journal of the American Medical Association titled “Vitamins for the Prevention of Colds.” The authors concluded, “Under the conditions of this controlled study, in which 980 colds were treated . . . there is no indication that vitamin C alone, an antihistamine alone, or vitamin C plus an antihistamine have any important effect on the duration or severity of infections of the upper respiratory tract.”

Other studies followed. After Pauling’s pronouncement, researchers at the University of Maryland gave 3,000 milligrams of vitamin C every day for three weeks to eleven volunteers and a sugar pill (placebo) to ten others. Then they infected volunteers with a common cold virus. All developed cold symptoms of similar duration. At the University of Toronto, researchers administered vitamin C or placebo to 3,500 volunteers. Again, vitamin C didn’t prevent colds, even in those receiving as much as 2,000 milligrams a day. In 2002, researchers in the Netherlands administered multivitamins or placebo to more than 600 volunteers. Again, no difference. At least 15 studies have now shown that vitamin C doesn’t treat the common cold. As a consequence, neither the FDA, the American Academy of Pediatrics, the American Medical Association, the American Dietetic Association, the Center for Human Nutrition at the Johns Hopkins Bloomberg School of Public Health, nor the Department of Health and Human Services recommend supplemental vitamin C for the prevention or treatment of colds.

Although study after study showed that he was wrong, Pauling refused to believe it, continuing to promote vitamin C in speeches, popular articles, and books. When he occasionally appeared before the media with obvious cold symptoms, he said he was suffering from allergies.

Then Linus Pauling upped the ante. He claimed that vitamin C not only prevented colds; it cured cancer.

In 1971, Pauling received a letter from Ewan Cameron, a Scottish surgeon from a tiny hospital outside Glasgow. Cameron wrote that cancer patients who were treated with ten grams of vitamin C every day had fared better than those who weren’t. Pauling was ecstatic. He decided to publish Cameron’s findings in the Proceedings of the National Academy of Sciences (PNAS). Pauling assumed that as a member of the academy he could publish a paper in PNAS whenever he wanted; only three papers submitted by academy members had been rejected in more than half a century. Pauling’s paper was rejected anyway, further tarnishing his reputation among scientists. Later, the paper was published in Oncology, a journal for cancer specialists. When researchers evaluated the data, the flaw became obvious: the cancer victims Cameron had treated with vitamin C were healthier at the start of therapy, so their outcomes were better. After that, scientists no longer took Pauling’s claims about vitamins seriously.

But Linus Pauling still had clout with the media. In 1971, he declared that vitamin C would cause a 10 percent decrease in deaths from cancer. In 1977, he went even further. “My present estimate is that a decrease of 75 percent can be achieved with vitamin C alone,” he wrote, “and a further decrease by use of other nutritional supplements.” With cancer in their rearview mirror, Pauling predicted, Americans would live longer, healthier lives. “Life expectancy will be 100 to 110 years,” he said, “and in the course of time, the maximum age might be 150 years.”

Cancer victims now had reason for hope. Wanting to participate in the Pauling miracle, they urged their doctors to give them massive doses of vitamin C. “For about seven or eight years, we were getting a lot of requests from our families to use high-dose vitamin C,” recalls John Maris, chief of oncology and director of the Center for Childhood Cancer Research at the Children’s Hospital of Philadelphia. “We struggled with that. They would say, ‘Doctor, do you have a Nobel Prize?’ ”

Blindsided, cancer researchers decided to test Pauling’s theory. Charles Moertel, of the Mayo Clinic, evaluated 150 cancer victims: half received ten grams of vitamin C a day and half didn’t. The vitamin C-treated group showed no difference in symptoms or mortality. Moertel concluded, “We were unable to show a therapeutic benefit of high-dose vitamin C.” Pauling was outraged. He wrote an angry letter to the New England Journal of Medicine, which had published the study, claiming that Moertel had missed the point. Of course vitamin C hadn’t worked: Moertel had treated patients who had already received chemotherapy. Pauling claimed that vitamin C worked only if cancer victims had received no prior chemotherapy.

Bullied, Moertel performed a second study; the results were the same. Moertel concluded, “Among patients with measurable disease, none had objective improvement. It can be concluded that high-dose vitamin C therapy is not effective against advanced malignant disease regardless of whether the patient had received any prior chemotherapy.” For most doctors, this was the end of it. But not for Linus Pauling. He was simply not to be contradicted. Cameron observed, “I have never seen him so upset. He regards the whole affair as a personal attack on his integrity.” Pauling thought Moertel’s study was a case of “fraud and deliberate misrepresentation.” He consulted lawyers about suing Moertel, but they talked him out of it.

Subsequent studies have consistently shown that vitamin C doesn’t treat cancer.

Pauling wasn’t finished. Next, he claimed that vitamin C, when taken with massive doses of vitamin A (25,000 international units) and vitamin E (400 to 1,600 IU), as well as selenium (a basic element) and beta-carotene (a precursor to vitamin A), could do more than just prevent colds and treat cancer; they could treat virtually every disease known to man. Pauling claimed that vitamins and supplements could cure heart disease, mental illness, pneumonia, hepatitis, polio, tuberculosis, measles, mumps, chickenpox, meningitis, shingles, fever blisters, cold sores, canker sores, warts, aging, allergies, asthma, arthritis, diabetes, retinal detachment, strokes, ulcers, shock, typhoid fever, tetanus, dysentery, whooping cough, leprosy, hay fever, burns, fractures, wounds, heat prostration, altitude sickness, radiation poisoning, glaucoma, kidney failure, influenza, bladder ailments, stress, rabies, and snakebites. When the AIDS virus entered the United States in the 1970s, Pauling claimed vitamins could treat that, too.

On April 6, 1992, the cover of Time — rimmed with colorful pills and capsule — declared: “The Real Power of Vitamins: New research shows they may help fight cancer, heart disease, and the ravages of aging.” The article, written by Anastasia Toufexis, echoed Pauling’s ill-founded, disproved notions about the wonders of megavitamins. “More and more scientists are starting to suspect that traditional medical views of vitamins and minerals have been too limited,” wrote Toufexis. “Vitamins — often in doses much higher than those usually recommended — may protect against a host of ills ranging from birth defects and cataracts to heart disease and cancer. Even more provocative are glimmerings that vitamins can stave off the normal ravages of aging.” Toufexis enthused that the “pharmaceutical giant Hoffman-La Roche is so enamored with beta-carotene that it plans to open a Freeport, Texas, plant next year that will churn out 350 tons of the nutrient annually, or enough to supply a daily 6 milligram capsule to virtually every American adult.”

The National Nutritional Foods Association (NNFA), a lobbying group for vitamin manufacturers, couldn’t believe its good luck, calling the Time article “a watershed event for the industry.” As part of an effort to get the FDA off their backs, the NNFA distributed multiple copies of the magazine to every member of Congress. Speaking at an NNFA trade show later in 1992, Toufexis said, “In fifteen years at Time I have written many health covers. But I have never seen anything like the response to the vitamin cover. It whipped off the sales racks, and we were inundated with requests for copies. There are no more copies. ‘Vitamins’ is the number-one-selling issue so far this year.”

Although studies had failed to support him, Pauling believed that vitamins and supplements had one property that made them cure-alls, a property that continues to be hawked on everything from ketchup to pomegranate juice and that rivals words like natural and organic for sales impact: antioxidant.

Antioxidation vs. oxidation has been billed as a contest between good and evil. The battle takes place in cellular organelles called mitochondria, where the body converts food to energy, a process that requires oxygen and so is called oxidation. One consequence of oxidation is the generation of electron scavengers called free radicals (evil). Free radicals can damage DNA, cell membranes, and the lining of arteries; not surprisingly, they’ve been linked to aging, cancer, and heart disease. To neutralize free radicals, the body makes its own antioxidants (good). Antioxidants can also be found in fruits and vegetables — specifically, selenium, beta-carotene, and vitamins A, C, and E. Studies have shown that people who eat more fruits and vegetables have a lower incidence of cancer and heart disease and live longer. The logic is obvious: if fruits and vegetables contain antioxidants — and people who eat lots of fruits and vegetables are healthier — then people who take supplemental antioxidants should also be healthier.

In fact, they’re less healthy.

In 1994, the National Cancer Institute, in collaboration with Finland’s National Public Health Institute, studied 29,000 Finnish men, all long-term smokers more than fifty years old. This group was chosen because they were at high risk for cancer and heart disease. Subjects were given vitamin E, beta-carotene, both, or neither. The results were clear: those taking vitamins and supplements were morelikely to die from lung cancer or heart disease than those who didn’t take them — the opposite of what researchers had anticipated.

In 1996, investigators from the Fred Hutchinson Cancer Research Center, in Seattle, studied 18,000 people who, because they had been exposed to asbestos, were at increased risk of lung cancer. Again, subjects received vitamin A, beta-carotene, both, or neither. Investigators ended the study abruptly when they realized that those who took vitamins and supplements were dying from cancer and heart disease at rates 28 and 17 percent higher, respectively, than those who didn’t.

In 2004, researchers from the University of Copenhagen reviewed fourteen randomized trials involving more than 170,000 people who took vitamins A, C, E, and beta-carotene to see whether antioxidants could prevent intestinal cancers. Again, antioxidants didn’t live up to the hype. The authors concluded, “We could not find evidence that antioxidant supplements can prevent gastrointestinal cancers; on the contrary, they seem to increase overall mortality.” When these same researchers evaluated the seven best studies, they found that death rates were 6 percent higher in those taking vitamins.

In 2005, researchers from Johns Hopkins School of Medicine evaluated nineteen studies involving more than 136,000people and found an increased risk of death associated with supplemental vitamin E. Dr. Benjamin Caballero, director of the Center for Human Nutrition at the Johns Hopkins Bloomberg School of Public Health, said, “This reaffirms what others have said. The evidence for supplementing with any vitamin, particularly vitamin E, is just not there. This idea that people have that [vitamins] will not hurt them may not be that simple.” That same year, a study published in the Journal of theAmerican Medical Association evaluated more than 9,000 people who took high-dose vitamin E to prevent cancer; those who took vitamin E were more likely to develop heart failure than those who didn’t.

In 2007, researchers from the National Cancer Institute examined 11,000 men who did or didn’t take multivitamins. Those who took multivitamins were twice as likely to die from advanced prostate cancer.

In 2008, a review of all existing studies involving more than 230,000 people who did or did not receive supplemental antioxidants found that vitamins increased the risk of cancer and heart disease.

On October 10, 2011, researchers from the University of Minnesota evaluated 39,000 older women and found that those who took supplemental multivitamins, magnesium, zinc, copper, and iron died at rates higher than those who didn’t. They concluded, “Based on existing evidence, we see little justification for the general and widespread use of dietary supplements.”

Two days later, on October 12, researchers from the Cleveland Clinic published the results of a study of 36,000 men who took vitamin E, selenium, both, or neither. They found that those receiving vitamin E had a 17 percent greater risk of prostate cancer. In response to the study, Steven Nissen, chairman of cardiology at the Cleveland Clinic, said, “The concept of multivitamins was sold to Americans by an eager nutraceutical industry to generate profits. There was never any scientific data supporting their usage.” On October 25, a headline in the Wall Street Journal asked, “Is This the End of Popping Vitamins?” Studies haven’t hurt sales. In 2010, the vitamin industry grossed $28 billion, up 4.4 percent from the year before. “The thing to do with [these reports] is just ride them out,” said Joseph Fortunato, chief executive of General Nutrition Centers. “We see no impact on our business.”

How could this be? Given that free radicals clearly damage cells — and given that people who eat diets rich in substances that neutralize free radicals are healthier — why did studies of supplemental antioxidants show they were harmful? The most likely explanation is that free radicals aren’t as evil as advertised. Although it’s clear that free radicals can damage DNA and disrupt cell membranes, that’s not always a bad thing. People need free radicals to kill bacteria and eliminate new cancer cells. But when people take large doses of antioxidants, the balance between free radical production and destruction might tip too much in one direction, causing an unnatural state in which the immune system is less able to kill harmful invaders. Researchers have called this “the antioxidant paradox.” Whatever the reason, the data are clear: high doses of vitamins and supplements increase the risk of heart disease and cancer; for this reason, not a single national or international organization responsible for the public’s health recommends them.

In May 1980, during an interview at Oregon State University, Linus Pauling was asked, “Does vitamin C have any side effects on long-term use of, let’s say, gram quantities?” Pauling’s answer was quick and decisive. “No,” he replied.

Seven months later, his wife was dead of stomach cancer. In 1994, Linus Pauling died of prostate cancer.


This is an excerpt from Do You Believe in Magic? The Sense and Nonsense of Alternative Medicine.

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