[COIN SPINNING]
ANNOUNCER: This is Planet Money, from NPR.
JANE BLACK: You may have noticed we’re living in the midst of a supplement craze. People are vitamaxxing, biohacking so they can live longer. Everyone’s talking about gut health.
SARAH GONZALEZ: 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, preworkouts, probiotics, fat-burners.
BLACK: There’s joint health, gut health. There’s glowing skin. I love glowing skin.
GONZALEZ: Better sleep, stronger nails, all of that.
BLACK: 75% of Americans take supplements.
GONZALEZ: A lot of people.
BLACK: Like, 100,000 different options you can choose from.
GONZALEZ: 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.
BLACK: Like, could we make a supplement?
GONZALEZ: OK, what if we want to make a supplement?
FRANK CANTONE: OK.
GONZALEZ: Like, a real NPR Planet Money branded supplement?
CANTONE: Awesome.
BLACK: This is Frank Cantone, the chiseled CEO of SMP Nutra, Supplement Manufacturing Partner. They make supplements.
CANTONE: Capsules, tablets, powders, soft gels, gummies.
BLACK: And then brands or influencers or podcasts sell them under their own labels.
GONZALEZ: I think it would be cool to have, like, a little microphone-shaped gummy, or a little planet, or little money gummy. [LAUGHS] A money gummy.
CANTONE: We could do those.
GONZALEZ: Or maybe we do a powder that you just, like, add water to and down it real quick.
BLACK: And it’s called the Money Shot.
CANTONE: [LAUGHS]
GONZALEZ: The Money Shot is the perfect name.
CANTONE: First and foremost, I think what’s important would be to define the market.
GONZALEZ: 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.
CANTONE: So do we want something that helps people focus? Do we want to help people have more energy? Is that the type of product that we want to offer?
GONZALEZ: That sounds great. I’m always tired.
BLACK: There are so many supplements already out there that claim to help with brain function or focus. There’s ashwagandha or theanine.
GONZALEZ: But for our potential focus gummy or shot, Frank actually suggests creatine, or lion’s mane, or other mushrooms if we want focus.
BLACK: Focus would be awesome. Also, I would like thicker hair.
CANTONE: OK.
BLACK: Can I do that?
CANTONE: Yeah. I mean, we could add collagen to this cocktail, which would help with hair growth and hair thickness.
GONZALEZ: Hold on. We’re gonna have a gummy that’s, like– it give you focus, and it gives you thicker hair?
CANTONE: It’s doable, for sure.
GONZALEZ: Is it smart?
CANTONE: I feel like it hits two needs that everyone really has a problem with, right?
BLACK: I love how Frank just wants to make things happen for us.
GONZALEZ: I know.
BLACK: If there is something that you want your mind or body to do, Frank will find the ingredient for you. Like, you want to burn fat? Maybe throw some green tea in there. Frank says people associate it with weight loss.
CANTONE: 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’s really there for some energy benefits.
BLACK: We walked through all the things– ingredients, shapes, flavors.
GONZALEZ: Kiwi?
CANTONE: For sure.
GONZALEZ: Honeydew? Honeydew’s a super good flavor.
CANTONE: No one does just kiwi. They do strawberry kiwi.
GONZALEZ: We talked colors. Ours would be green, of course. And right there on the spot, we got an estimate for the smallest possible order of our fully customized, I would argue, very tasty supplement.
CANTONE: It’s gonna be around 8,333 bottles. Based upon the ingredients we’re talking about, it’s gonna range from, like, $4.50 to $7.
GONZALEZ: $4 times 8,300-ish bottles?
CANTONE: Mm-hmm.
GONZALEZ: So $33,000, and then you do half up front.
BLACK: Which is not that bad if you’re looking to start your own business, but there is a cheaper option, too.
CANTONE: For our stock formulas, you’re in the game for, you know, $5,500.
GONZALEZ: 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.
CANTONE: Be happy to send you samples right after this call, and you could try that energy gummy on the website.
BLACK: Yep, they even had an energy gummy with green tea in it.
GONZALEZ: So could we say on the label, like, this will help with mental clarity and burn fat?
CANTONE: We’ll guide you down the right way to say it. I might say “supports metabolism” or–
GONZALEZ: Oh, I like this. OK, OK. Supports metabolism.
CANTONE: Exactly.
[MUSIC PLAYING]
GONZALEZ: Hello, and welcome to Planet Money. I’m Sarah Gonzalez.
BLACK: And I’m Jane Black.
GONZALEZ: 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.
BLACK: And if you think supplements are popular now, just wait. Sales are expected to double over the next seven years. Now, we are not going to make our own supplement. We are not going to sell one.
GONZALEZ: We were gonna do it.
BLACK: We were gonna do it.
GONZALEZ: We were gonna do it.
BLACK: You know, it started to make us a little bit nervous.
GONZALEZ: Which is kind of a bummer because we do want more energy.
BLACK: And thicker hair.
GONZALEZ: And thicker hair, apparently.
BLACK: It was so tempting, especially because it’s just so easy to make one.
GONZALEZ: The supplement industry has been fully cashing in on our love of silver bullets and a magic pill.
BLACK: Today on the show– how lax regulations are making that possible.
GONZALEZ: And why Americans wouldn’t have it any other way.
CANTONE: [LAUGHS]
BLACK: Yeah, like, what do you take?
CANTONE: Definitely taking a multivitamin, taking magnesium before bed. Berberine, typically before a heavy meal. I’m taking trace minerals. Take some diindolylmethane, boron, K2, and D3 in a fat-soluble soft gel, 15 grams of creatine before my second coffee.
GONZALEZ: Frank, this is so many supplements.
CANTONE: It’s not as many as you would think. It’s, like, on a given day, six or seven.
BLACK: OK, 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.
GONZALEZ: 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.
CANTONE: I just get vitamins ads and horse ads. That’s all I got.
GONZALEZ: Oh, OK.
BLACK: 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.
GONZALEZ: I would like to sleep better at night and have more energy during the day.
CANTONE: Yeah, so you’re not gonna 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. We’ve definitely got that request before.
GONZALEZ: [LAUGHS] 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.
CANTONE: You do have 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.
BLACK: Frank says a lot of people selling supplements came to this because supplements are a good business. Often, the people who come to the industry used to sell some other, less profitable products.
CANTONE: 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–
GONZALEZ: Water bottle and yoga mats? Yeah.
CANTONE: 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.
GONZALEZ: It’s hard to say exactly why supplements are so popular right now.
BLACK: 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.
GONZALEZ: 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, antiestablishment alternative.
BLACK: Even our own Health and Human Services secretary, RFK, Jr.– he’s a big fan of supplements. His acting FDA commissioner wants to make them even easier to make and to sell.
GONZALEZ: 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.
BLACK: 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 rat poison.
GONZALEZ: 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.
BLACK: 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.
GONZALEZ: His jaw fell off.
BLACK: Just disintegrated. It just completely disintegrated.
GONZALEZ: By the ’50s, doctors are calling all of this medical quackery. Wonder why.
BLACK: But it was really hard to do anything about it.
GONZALEZ: 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.
BLACK: Supplements have always been really hard to regulate. They’re kind of a food, because they’re to supplement 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.
GONZALEZ: 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.
BLACK: But people did not like that.
GONZALEZ: They did not.
BLACK: And Congress got more than 2 million letters, which was actually more than they ever got during Watergate. So no disclaimers.
GONZALEZ: Yeah, didn’t go through. In the ’70s, the FDA’s official position was still that supplements are, quote, “nutritionally irrational.”
BLACK: And that’s, like, a giant government exclamation point.
GONZALEZ: 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.
MELANIE BENESH: Massive consumer backlash.
BLACK: This is Melanie Benesh.
BENESH: The public really, really loves their supplements. Yeah.
BLACK: 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.
GONZALEZ: 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.
BLACK: 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.
GONZALEZ: They got people to write thousands of letters to President George HW 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.
BENESH: 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.
BLACK: Some stores even refuse to sell supplements on certain days to, you know, make people really live out the nightmare of this world without vitamins.
GONZALEZ: They got Mel Gibson to do an ad.
[AUDIO PLAYBACK]
GONZALEZ: 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.
-: – Freeze! Drug Enforcement!
BLACK: He’s standing in his bathrobe, and the FBI swoops in and knocks the vitamins out of his hands.
-: – Whoa! Whoa, guys! Hey, it’s only vitamins. It’s only– it’s only vitamins.
GONZALEZ: On the screen, it says, protect your right to use vitamins. Call Congress now.
-: – Vitamin C– you know, like in oranges?
[END PLAYBACK]
GONZALEZ: Congress gets an earful, and Congress gets the message. Supplements are kind of untouchable in the US.
BLACK: 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.
GONZALEZ: 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 health. And they could now claim this, as long as they avoided a couple key words.
BLACK: 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 memory, which is a pretty subtle distinction.
BENESH: 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.
GONZALEZ: Wait, is one of those OK, and the other one is not OK?
BENESH: Yeah. [LAUGHS]
GONZALEZ: They sound exactly the same.
BENESH: Yeah, so I have trouble distinguishing.
GONZALEZ: 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 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 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.”
BLACK: 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. And there is is nothing in the regulation that requires supplement makers to prove their product does what it says it does.
GONZALEZ: 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?
BENESH: Hopes and dreams?
GONZALEZ: The law also says you don’t even have to prove 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.
BLACK: 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.”
GONZALEZ: 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.
BLACK: It all started with a young man from Wisconsin.
BENESH: Who, I think, had this epiphany and really homed in on jellyfish.
GONZALEZ: 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.
BLACK: 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.
GONZALEZ: Diane, the mom, apparently tells her son about this.
BLACK: And he took to it like a dog with a bone.
GONZALEZ: Hold on, hold on, hold on.
BENESH: So it wasn’t even about memory? Why do we think that jellyfish have good memory?
GONZALEZ: Don’t they, like, famously not have brains?
BLACK: Yeah, exactly. They don’t have brains. But despite jellyfish not having brains–
GONZALEZ: Or hearts.
BLACK: –or hearts, Mark wants to make his memory-boosting jellyfish supplement anyway.
GONZALEZ: Yeah, and he’s not gonna use jellyfish from, like, the ocean for this, OK? He wants to use something that mimics the protein found in glowing jellyfish.
BLACK: Because they have to be glowing.
GONZALEZ: 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, “note cause any glowing.” Wow. [CHUCKLES] So it will not make you glow, but it will, apparently, improve memory.
BLACK: So what does it take for him to get that into stores or sell it online?
GONZALEZ: 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.
BLACK: 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.
GONZALEZ: 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.
BLACK: Aha.
GONZALEZ: 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.
BLACK: So if you’re having trouble getting 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.
BENESH: So put it in a protein shake or something else, and then now it’s part of the food supply.
GONZALEZ: 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.
BENESH: They said, aha! We’ll put it in food. And that was the birth of the Prevagen shake.
BLACK: 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.
GONZALEZ: 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.
BLACK: And once they got into food, that gave them the right to add it to the supplement. That is the get-around.
GONZALEZ: That is how we have the 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.
BLACK: 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.
GONZALEZ: 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, 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, vague promise there.
BLACK: But people are still buying it. It’s currently in the top five of Amazon’s list of blended vitamin and mineral supplements.
GONZALEZ: And listen, maybe synthetic, lab-made glowy fish stuff is one thing. 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.
BLACK: Take green tea supplements. 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 tea bag.
GONZALEZ: 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.
BLACK: Or turmeric supplements. They often contain 10 times the amount recommended by the World Health Organization.
[MUSIC PLAYING]
BLACK: 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.
GONZALEZ: Yeah, you’re probably not gonna want to hear this next part.
GONZALEZ: So I have these, like, gummies. “Vitamin C, Adult Gummies C” is what they’re called.
MARION NESTLE: And why are you taking that?
GONZALEZ: It’s like a little treat, you know? It’s like a gummy bear, except maybe there’s some vitamin C in there.
NESTLE: And you feel like you’re making yourself healthy.
GONZALEZ: This is Marion Nestle.
NESTLE: 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. Scurvy is not a major problem in the United States. It’s not a public health problem.
GONZALEZ: Yeah.
BLACK: 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.
NESTLE: I’m 89.
GONZALEZ: 89!
NESTLE: Good nutrition.
GONZALEZ: Good nutrition? Is that what you– so there’s nothing really bad you buy?
NESTLE: I buy tortilla chips. I buy ice cream. I buy all kinds of things. I eat my share of junk food.
GONZALEZ: But vitamins, supplements? Do you take any?
NESTLE: No.
GONZALEZ: No Vitamin D?
NESTLE: Vitamin D is not a vitamin. It’s a hormone that you get from exposure to the sun.
GONZALEZ: Sick burn, Marion.
NESTLE: Sorry.
GONZALEZ: So yeah, no vitamin supplements for this true legend.
NESTLE: 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.
BLACK: For Marion, it’s not just that supplements are unregulated, when the safety of their ingredients. She’s worried about an even more basic problem, like, what even are the ingredients?
NESTLE: Your turmeric supplement may or may not have turmeric in it.
GONZALEZ: What? Don’t you check the ingredient list and say– does it say turmeric as–
NESTLE: It doesn’t matter. It doesn’t have to have in it what it says on it.
BLACK: Technically, supplements are supposed to contain what they say they do. But–
NESTLE: 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.
GONZALEZ: Is that the same way with food? Like, if you read an ingredient in a food product–
NESTLE: No, no, no, no, no, no, no. No, that will be accurate.
BLACK: Yeah, because the FDA will sometimes spot-check food ingredients to make sure they’re for real.
GONZALEZ: But on a supplement–
NESTLE: You have no way of knowing.
BLACK: And sometimes supplements have stuff in there that really shouldn’t be in there.
NESTLE: Lead, arsenic, or other heavy metals.
GONZALEZ: There is a private supplement testing lab called Consumer Lab that Marion points to a lot. Its whole 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.
BLACK: And they have found similar variations in echinacea supplements and elderberry supplements. Consumer Labs found that more than 2/3 of elderberry supplements sold on Amazon did not contain authentic elderberry at all.
NESTLE: This is true of every supplement.
BLACK: Well, maybe not every, but–
NESTLE: I can’t think of a single supplement that Consumer Lab has investigated where it hasn’t found wide variation.
BLACK: According to a 2017 study, 20% of liver toxicity cases were tied to herbal and dietary supplements.
GONZALEZ: 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.
BLACK: Marion 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.
GONZALEZ: And Marion 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.
NESTLE: 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.
BLACK: I mean, to be honest, that kind of surprised me. I mean, Marion Nestle, woman of science, you would think, would be rabidly antisupplement. Honestly, she’s kind of like, do whatever you want, people.
NESTLE: 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 gonna argue with that. There’s nothing I can say to dissuade them, and I’m not even gonna try.
BLACK: Marion wrote the history on this. She knows that even when people see the science, it rarely makes them throw out their supplements.
GONZALEZ: 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.
BLACK: 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.
GONZALEZ: 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 Marion.
NESTLE: Supplements make people feel better. There’s absolutely no question about that.
GONZALEZ: Did she just say, supplements make people feel better?
BLACK: Yeah, but it’s not necessarily because their ingredients actually do what they say they’ll do.
GONZALEZ: Yeah, it’s this other thing.
NESTLE: It has a fabulous placebo effect.
GONZALEZ: Yeah. You feel like your vitamin C gummy helps you not catch a cold, and then you don’t catch a cold. Placebos, baby.
BLACK: Magic.
GONZALEZ: [LAUGHS]
NESTLE: 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, you know, I’m not gonna argue too much about it.
GONZALEZ: I love placebos.
NESTLE: Yeah, I do too.
GONZALEZ: They’re so powerful.
NESTLE: I do, too. I do, too. So if you’re gonna buy supplements, you buy from the most reputable company you can find and keep fingers crossed.
GONZALEZ: Just cross fingers, Jane.
BLACK: Thank you so much, Marion. I’m feeling good about this. I’m feeling really good.
GONZALEZ: You know what gets me about all this, Jane? If supplement makers were to just be, like, fully transparent, 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.
BLACK: Yeah, probably not. I mean, we’ve got 100 years of history that says nothing is gonna come between Americans and their supplements.
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GONZALEZ: But you don’t even take supplements, Jane.
BLACK: Right, I know. I mean, nothing’s gonna come between you and your supplements.
[LAUGHTER]
GONZALEZ: This episode was produced by Sam Yellowhorse Kesler, who takes fish oil; edited by Marianne 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.
BLACK: Special thanks to Jensen Jose at the Center for Science in the Public Interest, and Chiara Eisner, who wrote that great Wired article and now works for NPR.
[CHEERING, LAUGHING]
GONZALEZ: I’m Sarah Gonzalez.
BLACK: And I’m Jane Black. This is NPR. Thanks for listening.
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