Are There Any Honest Nutritional Supplement Companies?

Written by Dr. Steve Chaney on . Posted in Uncategorized

Do They “Cherry Pick” Scientific Studies?

Author: Dr. Stephen Chaney

cherry picking studiesWhen we buy a food supplement from a company we assume that it will provide a benefit. We are trusting that company to be honest in their product claims. But, are there any honest nutritional supplement companies?

  • What if they were lying to us?
  • What if they had no clinical studies done with their product?
  • What if they were just quoting studies done with ingredients found in their product?
  • What if they were “cherry picking” the studies they listed to support the claims they wanted to make?

Unfortunately, that happens far too often in the nutraceutical industry. As an example, I came across an article in a recent issue of www.nutraingredients.com about a FDA warning letter (http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/2016/ucm518533.htm) to a noni juice company.  In case you are wondering, noni fruit is the latest in a long line of “magical fruits” that is going to cure everything that ails you.

The thing that brought this company to the FDA’s attention in the first place was the health claims the company made on their website. The company claimed or implied that their product would cure cancer, cure gout, cure arthritis, lower cholesterol, and help fight infections. Claims like that always invite FDA scrutiny.

What caught my attention, however, was the quote by an attorney specializing in FDA compliance issues that the studies cited on their website were “cherry picked” to support their claims. He said that the studies they cited “…do not meet the standards of third party literature…You have to include a full range [of published studies], and not just cherry pick the positive studies. It has to be a balanced presentation. It looks like they just did a literature search on noni and included only the positive studies.”

That statement caught my attention because it doesn’t just apply to just this one company. It is a practice that is common in the nutraceutical industry.  Many supplement companies cherry pick studies from third party literature. They list only the studies that support their product claims and ignore the rest. That is misleading because it implies a level of proof for their product claims that does not exist.  It is fundamentally dishonest. These are certainly not honest nutritional supplement companies.

Using Borrowed Science

honest nutritional supplement companiesThe noni juice company cited in the FDA letter had no clinical studies to support their claims. Instead they quoted studies done with ingredients found in their product. This is what I call “borrowed science.”

I call this “borrowed science” because the studies were not actually done with their products. They were simply trying to “borrow” results done with individual ingredients and pretend that they applied them to their product.

Let me be clear. Third party studies done with ingredients found in a company’s product are of little value in predicting whether that product will provide any benefit to you. To claim otherwise is dishonest.  Again, these are not honest nutritional supplement companies.

There are several reasons this is true.

  • In many cases, the amount of that ingredient provided by the supplement does not match the amount actually used in the clinical study they quote. The ingredient may or may not be effective at the dose provided in the supplement.
  • More importantly, a supplement usually contains multiple other components that may influence how a single ingredient works in your body. The other components may enhance the effectiveness of the ingredient in question, or they may inhibit it.
  • Without clinical trials done with their product, companies actually have no idea whether their product works or not.

Unfortunately, I see this practice all too frequently in the nutraceutical industry. Clinical trials are expensive. It’s cheaper and easier to search the literature for published studies you can “borrow” to support your product.

 

Honest Nutritional Supplement Companies Do Not“Cherry Pick” Studies

dishonest supplement companiesEven worse, many companies cherry pick studies from the literature to support the product claims they want to make.

To understand what that statement means you need to know a little bit about the scientific method. Most scientists design their experiments to disprove what other scientists have published. This is a self-correcting process that is a strength of the scientific method.

However, it also means that you will find articles in the literature supporting and refuting the benefits of almost every nutraceutical ingredient. The scientific community waits until enough studies have accumulated and then relies on the weight of evidence before drawing any conclusions.

Unfortunately, unscrupulous supplement companies decide first on what claims they want to make and quote only the studies that support those claims. This is what is referred to as “cherry picking” the studies.

The Dietary Supplement Health and Education Act of 1994 (otherwise known as DSHEA) is very clear about that. Section 5 of DSHEA states “…scientific journal articles, books and other publications can be used in the sale of dietary supplements provided…[they] are presented with other materials to create a balanced view of the scientific information…”

In plain words this legalese simply means that you can’t cherry pick studies. You can’t select only the studies that support your product claims and ignore those that don’t.  Honest nutritional supplement companies would not use these deceitful practices.

However, this is a practice that I see all too often in the nutraceutical industry. It is dishonest. It is disgraceful

 

Are There Any Honest Nutritional Supplement Companies?

The bad news is that there are lots of supplement companies that do no clinical studies of their own. Instead they rely on borrowed science from studies that really do not provide proof that their products are either safe or effective. Even worse, many of those companies cherry pick only the studies that support their product claims and ignore studies that do not. This is a practice I regard as clearly dishonest. Those are companies I would avoid.

The good news is that there are a few companies that actually support clinical studies on their key products and publish those studies in peer reviewed scientific journals. Those are companies worthy of your consideration.

There are other things to take into account in selecting the best of the best – things like the number of studies and the quality of the studies. However, that’s a topic for another day.

 

Many Blogs Cherry Pick As Well

deceitful supplement companiesI can’t leave this topic without pointing out that many popular health and nutrition blogs, including those written by some well-known doctors, do exactly the same thing.

The pressures that lead to this behavior are obvious. The very popularity of these blogs depends on them being sensational week after week.

Unfortunately, true science is rarely sensational. It’s usually pretty wishy-washy. If you do a complete search of the literature, you usually find articles that are both for and against any point of view you wish to express. Occasionally, enough evidence accumulates on one side of an issue that scientists are willing to come to a definitive conclusion, but that conclusion is hardly ever sensational.

The only way that the authors of these popular blogs can make sensational claims each week is to cherry pick only the studies that support their point of view and ignore everything else.

Unfortunately, the average reader doesn’t realize this. They see the list of references supporting the claims and believe what they read. Then these bizarre claims get reposted over and over until the general public actually starts believing that they are true.

It really is a shame that DSHEA doesn’t apply to blogs. If it did, they wouldn’t be nearly as sensational, but they would be much more accurate. They would have to report on the whole body of scientific literature, rather than cherry picking just the studies that support their point of view.

In conclusion, there are some honest nutritional supplement companies, but be sure the company you choose to believe is citing studies on their actual products and not just ingredients in their products.  Also, watch out for “cherry picking.”

 

The Bottom Line

 

  • The FDA recently sent a warning letter to a noni juice company for making unsupported health claims for their product. The company was claiming their product could cure things like cancer, gout and arthritis. Whenever a company makes claims like that, they can expect to draw the attention of the FDA.
  • An outside attorney specializing in FDA compliance pointed out that the company also had no good evidence to support their product claims. The company had done no clinical studies on the products. Instead they had “borrowed” the results of third party studies done with ingredients found in their product. Even worse, they had cherry picked only the studies that supported their product claims and ignored the studies that did not.
  • Third party studies done with ingredients found in a company’s product are often worthless in predicting whether that product will provide any benefit to you. I discuss the reasons for that in the article above.
  • Cherry picking only the studies that support a company’s product claims runs afoul of the Dietary Supplement Health and Education Act of 1994 (DSHEA) requirement that companies provide a balanced view of the scientific literature relating to their products. It is also misleading and dishonest.
  • Unfortunately, the practice of using “borrowed science” from third party studies and cherry picking only the studies that support their product claims is common in the nutraceutical industry. Supplement companies that rely on this kind of evidence to support their product claims are dishonest and should be avoided.
  • For products you can trust, choose companies that support clinical studies on their key products and published those studies in peer-reviewed journals. You should also look at the number and quality of studies, but that is a topic for another day.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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A Low Carb Diet and Weight Loss

Posted January 15, 2019 by Dr. Steve Chaney

Do Low-Carb Diets Help Maintain Weight Loss?

Author: Dr. Stephen Chaney

 

low carb dietTraditional diets have been based on counting calories, but are all calories equal? Low-carb enthusiasts have long claimed that diets high in sugar and refined carbs cause obesity. Their hypothesis is based on the fact that high blood sugar levels cause a spike in insulin levels, and insulin promotes fat storage.

The problem is that there has been scant evidence to support that hypothesis. In fact, a recent meta-analysis of 32 published clinical studies (KD Hall and J Guo, Gastroenterology, 152: 1718-1727, 2017 ) concluded that low-fat diets resulted in a higher metabolic rate and greater fat loss than isocaloric low-carbohydrate diets.

However, low-carb enthusiasts persisted. They argued that the studies included in the meta-analysis were too short to adequately measure the metabolic effects of a low-carb diet. Recently, a study has been published in the British Medical Journal (CB Ebbeling et al, BMJ 2018, 363:k4583 ) that appears to vindicate their position.

Are low carb diets best for long term weight loss?

Low-carb enthusiasts claim the study conclusively shows that low-carb diets are best for losing weight and for keeping it off once you have lost it. They are saying that it is time to shift away from counting calories and from promoting low-fat diets and focus on low-carb diets instead if we wish to solve the obesity epidemic. In this article I will focus on three issues:

  • How good was the study?
  • What were its limitations?
  • Are the claims justified?

 

How Was The Study Designed?

low carb diet studyThe investigators started with 234 overweight adults (30% male, 78% white, average age 40, BMI 32) recruited from the campus of Framingham State University in Massachusetts. All participants were put on a diet that restricted calories to 60% of estimated needs for 10 weeks. The diet consisted of 45% of calories from carbohydrate, 30% from fat, and 25% from protein. [So much for the claim that the study showed low-carb diets were more effective for weight loss. The diet used for the weight loss portion of the diet was not low-carb.]

During the initial phase of the study 161 of the participants achieved 10% weight loss. These participants were randomly divided into 3 groups for the weight maintenance phase of the study.

  • The diet composition of the high-carb group was 60% carbohydrate, 20% fat, and 20% protein.
  • The diet composition of the moderate-carb group was 40% carbohydrate, 40% fat, and 20% protein.
  • The diet composition of the low-carb group was 20% carbohydrate, 60% fat, and 20% protein.

Other important characteristics of the study were:

  • The weight maintenance portion of the study lasted 5 months – much longer than any previous study.
  • All meals were designed by dietitians and prepared by a commercial food service. The meals were either served in a cafeteria or packaged to be taken home by the participants.
  • The caloric content of the meals was individually adjusted on a weekly basis so that weight was kept within a ± 4-pound range during the 5-month maintenance phase.
  • Sugar, saturated fat, and sodium were limited and kept relatively constant among the 3 diets.

120 participants made it through the 5-month maintenance phase.

 

Do Low-Carb Diets Help Maintain Weight Loss?

low carb diet maintain weight lossThe results were striking:

  • The low-carb group burned an additional 278 calories/day compared to the high-carb group and 131 calories/day more than the moderate-carbohydrate group.
  • These differences were even higher for those individuals with higher insulin secretion at the beginning of the maintenance phase of the study.
  • These differences lead the authors to hypothesize that low-carb diets might be more effective for weight maintenance than other diets.

 

What Are The Pros And Cons Of This Study?

low carb diet pros and consThis was a very well-done study. In fact, it is the most ambitious and well-controlled study of its kind. However, like any other clinical study, it has its limitations. It also needs to be repeated.

The pros of the study are obvious. It was a long study and the dietary intake of the participants was tightly controlled.

As for cons, here are the three limitations of the study listed by the authors:

#1: Potential Measurement Error: This section of the paper was a highly technical consideration of the method used to measure energy expenditure. Suffice it to say that the method they used to measure calories burned per day may overestimate calories burned in the low-carb group. That, of course, would invalidate the major findings of the study. It is unlikely, but it is why the study needs to be repeated using a different measure of energy expenditure.

#2: Compliance: Although the participants were provided with all their meals, there was no way of being sure they ate them. There was also no way of knowing whether they may have eaten other foods in addition to the food they were provided. Again, this is unlikely, but cannot be eliminated from consideration.

#3: Generalizability: This is simply an acknowledgement that the greatest strength of this study is also its greatest weakness. The authors acknowledged that their study was conducted in such a tightly controlled manner it is difficult to translate their findings to the real world. For example:

  • Sugar and saturated fat were restricted and were at very similar levels in all 3 diets. In the real world, people consuming a high-carb diet are likely to consume more sugar than people in the other diet groups. Similarly, people consuming the low-carb diet are likely to consume more saturated fat than people in the other diet groups.
  • Weight was kept constant in the weight maintenance phase by constantly adjusting caloric intake. Unfortunately, this seldom happens in the real world. Most people gain weight once they go off their diet – and this is just as true with low-carb diets as with other diets.
  • The participants had access to dietitian-designed prepared meals 3 times a day for 5 months. This almost never happens in the real world. The authors said “…these results [their data] must be reconciled with the long-term weight loss trials relying on nutrition education and behavioral counseling that find only a small advantage for low carbohydrate compared with low fat diets according to several recent meta-analyses.” [I would add that in the real world, people do not even have access to nutritional education and behavioral modification.]

 

low carb diet and youWhat Does This Study Mean For You?

  • This study shows that under very tightly controlled conditions (dietitian-prepared meals, sugar and saturated fat limited to healthy levels, calories continually adjusted so that weight remains constant) a low-carb diet burns more calories per day than a moderate-carb or high-carb diet. These findings show that it is theoretically possible to increase your metabolic weight and successfully maintain a healthy weight on a low-carb diet. These are the headlines you probably saw. However, a careful reading of the study provides a much more nuanced viewpoint. For example, the fact that the study conditions were so tightly controlled makes it difficult to translate these findings to the real world.
  • In fact, the authors of the study acknowledged that multiple clinical studies show this almost never happens in the real world. These studies show that most people regain the weight they have lost on low-carb diets. More importantly, the rate of weight regain is virtually identical on low-carb and low-fat diets. Consequently, the authors of the current study concluded “…translation [of their results to the real world] requires exploration in future mechanistic oriented research.” Simply put, the authors are saying that more research is needed to provide a mechanistic explanation for this discrepancy before one can make recommendations that are relevant to weight loss and weight maintenance in the real world.
  • The authors also discussed the results of their study in light of a recent, well-designed 12-month study (CD Gardener et al, JAMA, 319: 667-669, 2018 ) that showed no difference in weight change between a healthy low-fat versus a healthy low-carbohydrate diet. That study also reported that the results were unaffected by insulin secretion at baseline. The authors of the current study noted that “…[in the previous study] participants were instructed to minimize or eliminate refined grains and added sugars and maximize intake of vegetables. Probably for this reason, the reported glycemic load [effect of the diet on blood sugar levels] of the low-fat diet was very low…and similar to [the low-carb diet].” In short, the authors of the current study were acknowledging that diets which focus on healthy, plant-based carbohydrates and eliminate sugar, refined grains, and processed foods may be as effective as low-carb diets for helping maintain a healthy weight.
  • This would also be consistent with previous studies showing that primarily plant-based, low-carb diets are more effective at maintaining a healthy weight and better health outcomes long-term than the typical American version of the low-fat diet, which is high in sugar and refined grains. In contrast, meat-based, low-carb diets are no more effective than the American version of the low-fat diet at preventing weight gain and poor health outcomes. I have covered these studies in detail in my book “Slaying The Food Myths.”

Consequently, the lead author of the most recent study has said: “The findings [of this study] do not impugn whole fruits, beans and other unprocessed carbohydrates. Rather, the study suggests that reducing foods with added sugar, flour, and other refined carbohydrates could help people maintain weight loss….” This is something we all can agree on, but strangely this is not reflected in the headlines you may have seen in the media.

The Bottom Line

 

  • A recent study compared the calories burned per day on a low-carb, moderate-carb, and high-carb diet. The study concluded that the low-carb diet burned significantly more calories per day than the other two diets and might be suitable for long-term weight control. If confirmed by subsequent studies, this would be the first real evidence that low-carb diets are superior for maintaining a healthy weight.
  • However, the study has some major limitations. For example, it used a methodology that may overestimate the benefits of a low-carb diet, and it was performed under tightly controlled conditions that can never be duplicated in the real world. As acknowledged by the authors, this study is also contradicted by multiple previous studies. Further studies will be required to confirm the results of this study and show how it can be applied in the real world.
  • In addition, the kind of carbohydrate in the diet is every bit as important as the amount of carbohydrate. The authors acknowledge that the differences seen in their study apply mainly to carbohydrates from sugar, refined grains, and processed foods. They advocate diets with low glycemic load (small effects on blood sugar and insulin levels) and acknowledge this can also be achieved by incorporating low-glycemic load, plant-based carbohydrates into your diet. This is something we all can agree on, but strangely this is not reflected in the headlines you may have seen in the media.
  • Finally, clinical studies report averages, but none of us are average. When you examine the data from the current study, it is evident that some participants burned more calories per hour on the high-carb diet than other participants did on the low carb diet. That reinforces the observation that some people lose weight more effectively on low-carb diets while others lose weight more effectively on low-fat diets. If you are someone who does better on a low-carb diet, the best available evidence suggests you will have better long-term health outcomes on a primarily plant-based, low-carb diet such as the low-carb version of the Mediterranean diet.

For more details read the article above.

 

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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