The Powerful Placebo Effect Of Supplements

This message comes from Insperity, providing HR services and technology, from payroll, benefits, and HR compliance to talent development. Learn more at inspirity.comslash HR Matters . This is Plan et Money from NPR. You may have noticed we are living in the midst of a supplement craze. People are Vitamaxing, biohacking so they can live longer. Everyone's talking about gut health. I feel very aware of my gut health right now. It's true. The supplement industry is a $70 billion industry in the United States and growing fast. We are talking protein powders, pre-workouts, probiotics, fat burners. There's joint health, gut health, there's glowing skin. I love glowing skin. Stronger nails, all of that. 75% of Americans take supplements. A lot of people. Yeah. L aike hundred , thousand different options you can choose from. 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. Like could we make a supplement? Okay, what if we want to make a supplement? Okay. Like a real NPR planet money branded supplement. Awesome. This is Frank Cantone, the Chiseled CEO of SMP Nutra Supplement Manufacturing partner, they make supplements. Capsules, tablets, powders, soft gels, gummies. And then brands or influencers or podcasts sell them under their own labels. I think it would be cool to have like a little microphone shaped gummy or a little planet or a little money gummy. A money gummy. We could do those. Or maybe we do a powder that you just like add water to and down it real quick. And it's called the money shot. The money shot is the perfect name. First and foremost, I think what's important would be to define the market. 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. So do we want something that helps people focus, right? Do we want to help people have more energy? Is that the type of product that we want to offer? That sounds great. I'm always tired. There are so many supplements already out there that claim to help with brain function or focus. There's ashwagandha or theanine. But for our potential focus gummy or shot, Frank actually suggests creatine or lion's mane or other mushrooms if we want focus. Focus would be awesome. Also, I would like thicker hair. Okay. Can I do that? Yeah, I mean we could add collagen to this cocktail which would help with hair growth and hair thickness hold on we're gonna have a gummy that's like it gives you focus and it gives you thicker hair it's doable for sure is it smart ? I feel like it it hits two needs that everyone really has a problem with, right? I love how Frank just wants to make things happen for us. I know. If there is something that you want your mind or your body to do, Frank will find the ingredient for you. Like uh you wanna burn fat, maybe throw some green tea in there. Frank says people associate it with weight loss. It's typically found in weight management products, so they can kind of put it in that boat if they want to, but the green tea is really there for some energy benefits. We walk through all the things: ingredients, shapes, flavors, kiwi, kiwi for sure. Honeydew, honeydew is a super no one does just kiwi . Oh 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. It's gonna be around eight thousand three hundred and thirty three bottles. Based upon the ingredients we're talking about, it's gonna range from like four dollars and fifty cents to seven dollars. Four dollars times eight thousand three hundred ish bottles. Mm-hmm. So thirty three thousand and then you do half up front. Which is not that bad if you're looking to start your own business, but there is a cheaper option too. For our stock formulas, you're in the game for you know $5,500 bucks. 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. Be happy to send you samples right after this call and could try that energy gummy on the website. Yep, they even had an energy gummy with green tea in it. So could we say on the label like Like this will help with mental clarity and burn fat . We'll guide you down the right way to say it. Um I say supports metabolism. Oh or you know okay, okay, supports metabolism. Exactly . Hello and welcome to Planet Money. I'm Sarah Gonzalez. And I'm Jane Black. 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. 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 gonna sell one. We were gonna do it. We were gonna do it. We were gonna do it. You know, started to make us a little bit nervous, which is kind of a bummer because we do want more energy. And thicker hair. And thicker hair, apparently. It was so tempting. Especially because it's just so easy to make one. The supplement industry has been fully cashing in on our love of silver bullets and a magic pill. Today on the show, how lax regulations are making that possible and why Americans wouldn't have it any other way. Yeah, like what do you take? Definitely taking a multivitamin, taking magnesium before bed, berberine, typically before a heavy meal. I'm taking trace minerals, take some dyne dolymethane, oron, K2, and D3 in a fat-soluble soft gel, 15 grams of creatine before my second call . Frank, this is so many supplements. It's not as many as you would think. It's like on a given day, six or seven. This message comes from Insparity, providing HR services and technology, from payroll, benefits, and HR compliance to talent development. Learn more at inspirity.com slash HR Matters. This message comes from Schwab. With the new Schwab Teen Investor Account, teens can gain hands-on investing experience. It's co-owned by you and your teen, so you can Learn more at schwab.com. This message comes from Capella University. You know that feeling when there's a spark building inside you that you were meant for more? That's your own drive, pushing you towards what's next. Capella University gets that. With their FlexPath learning format, you can set the pace and earn your degree without putting life on pause. You've built experience and know what you're capable of. Now, this is your time to turn that momentum into more. The only real question is: what can't you do? Learn more at capella.edu. This message comes from BetterHelp. Summer can feel like a sprint, kids home, trips to plan, routines flipped upside down. It's easy to slip into survival mode, just trying to get through it. Then suddenly, it's over, and you're wishing you enjoyed the days just a little bit more. Therapy can help you slow down and actually be present for the moments that matter. With betterHelp, you can connect with a licensed therapist from anywhere on your schedule. Don't just survive the summer. Thrive. Visit betterhelp.com/slash NPR . Okay, we are not here to prove or disprove whether supplements work, but we do want to say that experts and scientists tend to agree there is no evidence that supplements make healthy people healthy err. 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. I just get vitamins ads and horse ads. That's all I want. Okay . 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. I would like to sleep better at night and have more energy during the day. Yeah, so you're not going to be able to make one product that puts you to sleep and then wakes you back up. We've had people try to do that. We definitely got that request before. 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. You do have your bad actors where someone comes to us, we want to make this, and we say, Well, that is not exactly possible. So they'll go to someone else and they'll say, Hey, can you make this? Someone says yes. All of a sudden it's in the market, but no one's checked what's really in it. Frank says a lot of people selling supplements came to this business because supplements are a good business. Often the people who come to the industry used to sell some other, less profitable products. 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, water bottles. Yoga mats.. Right Yeah, he's gonna use it once or twice. I can sell him the same green superfruit powder every month, and that customer lifetime value is gonna go way up. It's hard to say exactly why supplements are so popular right now. Frank told us that the supplement business really, really took off during COVID. In fact, supplement sales have increased around fifty percent since before the pandemic. There's also the wellness influencers on TikTok and Instagram. They've also contributed to the jump in sales. And then there's also just like a lot of distrust in institutions and the government and the pharmaceutical industry right now. And even though supplement makers are companies too, people feel like they're this more natural anti-establishment alternative. 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. 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. 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. Sounds lovely. Uh 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. 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. His jaw fell off. Just disintegrated. It just completely disintegrated. Wonder why. But it was really hard to do anything about it. 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 regul ations. Supplements have always been really hard to regulate. They're kind of a food because you know they're designed to supplement your diet. But they're also pills or gummies or powders, you know, they come in a jar with a label claiming to address your health problems. They feel like a drug, but drugs have to go through this really rigorous test ing to prove that they work. Supplements do not. Supplements live in this weird no-man's land. When the Food and Drug Administration was created in 1906, there was no mention of supplements, but over the the years 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. But people do not like that. They do not. And Congress got more than two million letters, which was actually more than they ever got during Watergate. So no disclaimers. Yeah, didn't go through. In the 70s, the FDA's official position was still that supplements are quote nutritionally irrational. That's like a giant government exclamation point. 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. Massive consumer backlash. This is Melanie Banish. The public really, really loves their supplements. Yeah. Melanie is a lawyer who focuses on food and drug regulations at the Environmental Working Group, which has for years advocated for safer consumer products and more regulation. She says the last time Congress even attempted to regulate supplements was in the early 90s, and the consumer revolt that followed basically killed any serious effort to regulate supplements ever again. 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. 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. They got people to write thousands of letters to President George H.W. Bush, to Congress and the FDA saying, like, please, please, please, please, please do not touch our supplements. They even got health food stores to join in on the revolt. 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. 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. Um they got Mel Gibson to do an ad. In the ad, you see a SWAT team kicking open the door of their SWAT band. 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. He's standing in his bathrobe and the FBI swoops in and knocks the vitamins out of his hands. Oh! Oh! Guys, hey, it's only vitamins. It's only it's only vitamins. On the screen, it says protect your right to use vitamins. Call Congress now. Vitamin C, you know, like in oranges. Congress gets an earful and Congress gets the mess age. Supplements are kind of untouchable in the U.S. 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 In fact, the law gave supplement makers more freedom, including something they'd always wanted, the legal right to claim on their labels that supplements were actually improving your health. And they could now claim this as long as they avoided a couple keywords. Okay, so a supplement maker cannot say their pill diagnoses, prevents, cures, treats, or mitigates a disease, like Alzheimer's. But they can say it helps improve your memory, which is a pretty subtle distinction. 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. Wait, is one of those okay and the other one is not okay? Yeah. They sound exactly the same. Yeah. So I have trouble distinguishing. This is the thing that the supplement maker Frank was kind of like guiding us on, right? He's like, you can't say it burns fat. You gotta say it supports metabolism. So here's a little news you can use. Melanie says, if the front of your supplement bottle says supports X or promotes why, that should be a signal to you that it is not actually proven to do anything. If you turn over your supplement bottle right now, you will even see in tiny fine print that the claims on the bottle have, quote, not been evaluated by the FDA. And sure, the supplement makers are supposed to have something to back up their claims. And there are a bunch of studies out there that say these things work. But you have to look at how good those studies are and who's funding them. There's a lot of conflict of interest there. There is nothing in the regulation that requires supplement makers to prove their product does what it says it does. 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? Uh hopes and dreams. The law also says you don't even have to prove your supplement is safe before you sell it to people. Unless there's one unless, unless it is a brand new, never before used ingredient in a supplement. Then you do need to show some some paperwork. 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 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. 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. It all started with a young man from Wisconsin. Who I think had this epiphany in really homed in on jellyfish. Every good supplement starts with an epiphany. This was in the nineties. 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. 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. Diane, the mom, apparently tells her son about this. And he took to it like a dog with a bone. Hold on, hold on, hold on. So it it wasn't even about memory? Why did we think that jellyfish have good memory? Don't they like famously not have brains? Exactly. They don't have brains. But despite jellyfish not having brains. Or hearts. Or carts. Mark wants to make his memory-boosting jellyfish supplement anyway. Yeah, and he's not gonna use jellyfish from like the ocean for this, okay? He wants to use something that mimics the protein found in glowing jellyfish. Because they have to be glowing. So this is a synthetic made-in-alab version of the protein that causes jellyfish to glow, okay? And he sets out to now sell that produ ct. And on his marketing material, he promises his supplement will quote not cause any glowing. Wow. So it will not make you glow, but it will apparently improve your memory. So what does it take for him to get that into stores or sell it online? 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. And when the company ran it by the FDA again a few years later, FDA says, nope, but we still don't think it's safe enough. 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. Uh-huh. 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 grass, G R-A-S. So if you're having trouble getting your new supplement ingredient, like glowy jellyfish stuff, pass the FDA's review process, Melanie says you can just put it in a food product first. So put it in a protein shake or something else, and then now it's part of the food supplies. 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. They said, aha , we'll put it in food. And that was the birth of the Previgin Shake. The Previgin 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. 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. And once they got into food, that gave them the right to add it to the supplement. That is the get-around. 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. Between 2007 and 2015, the Jellyfish Company racked up more than 1$65 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. And the FTC did that with the Jellyfish Supplement. They sued in 2017 and just a short, almost eight years later, the NT won its case. The company was claiming that their product was clinically proven to improve memory. And the FTC said, um, there's one clinical trial, and it did not show their supplement improved memory. So now the label just says prevogen for your brain. Nice. Vague promise there. But people are still buying it. It's currently in the top five of Amazon's list of blended vitamin and mineral supplements. And listen, maybe synthetic lab-made glowy fish stuff is one thing, right? Like maybe that feels totally different from, say, fish oil or collagen or herbal supplements, like turmeric pills. But Melanie says even the ones that seem all natural or super familiar may not be what you think. 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 your tea bag. 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, EG, CG extract is linked to acute liver damage and sometimes death. Or turmeric supplements. They often contain 10 times the amount recommended by the World Health Organization. After the break, we're talking about the regular, everyday, familiar herbal supplements and vitamins that so many of us have in our kitchens right now. Yeah, you're probably not gonna want to hear this next part. This message comes from Schwab. With the new Schwab Teen Investor Account, teens can gain hands-on investing experience. It's co-owned by you and your teen, so you can monitor the account while your teen learns how to invest and manage money This message comes from Capella University. That spark you feel? That's your drive for more. Capella University's FlexPath Learning Format lets you earn your degree at your pace without putting life on pause. Learn more at Kapella.edu. Support for NPR and the following message comes from Rippling. These days, you can chat with AI about almost any business problem, but Rippling AI is designed to actually solve them. That's because Rippling AI is built on your live global workforce data. So it doesn't just uncover insights into your business, it uses them to take complex ac tions across your departments. Ready for AI that isn't all talk? Head to rippling.ai slash money and get AI that turns insight into action. That's R-I-P-P-L-I-E I n G dot AI slash money. Sign up today. This message comes from Dell Technologies. Interruptions happen at work, but with the Dell Pro laptop powered by Intel Core Ultra with V Pro, built with optimized battery and built-in intelligence, your tech won't slow you down. Dell.com slash Dell dash Pro built for you. So I have these like gummies, vitamin C , adult gummies C is what they're called. It's like a little treat, you know, it's like a it's like a gummy bear, except maybe there's some vitamin C in there. And you feel like you're making yourself healthy. This is Marian Nessel. If you're vitamin C deficient, it could be quite useful. I don't know anybody who's vitamin C deficient if they eat any fruits and vegetables at all. Scurvy is not a major problem in the United States. It's not a public health problem. Yeah. 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. I'm eighty nine. Eighty nine . Good nutrition. Good nutrition is that what you So there's nothing really bad you buy. I buy tortilla chips. I buy ice cream. I buy all kinds of things. I eat my share of junk food. But vitamins? Supplements? Do you take any? No. No vitamin D? Vitamin D is not a vitamin. It's a hormone that you get from exposure to the sun? Sick burn Marion. Sorry. So yeah. No vitamin supplements for this true legend. I wouldn't take it because I don't know what's in those packages. What it says on the label is not what's in the package. For Marion, it's not just that supplements are unregulated when it comes to the safety of their ingredients. She's worried about an even more basic problem. Like what even are the ingredients? Your turmeric supplement may or may not have turmeric in it. What don't you check the ingredient list and say does it say turmeric as an ingredient in it doesn't matter. It doesn't have to have in it it what says on it. Technically supplements are supposed to contain what they say they do. But nobody has the resources to check and see whether those supplements have in them what it says Aaron Powell Is that is it the same way with food? Like if you read an ingredient in a food , no, that will be accurate. Yeah, because the FDA will sometimes spot check food ingredients to make sure they're for real. But on a supplement You have no way of knowing. And and sometimes supplements have stuff in there that really shouldn't be in there. Lead, arsenic, or other heavy metals. There is a private supplement testing lab called Consumer Lab that Marion points to a lot. Its whole business is testing supplements to see what is actually in them. And recently they tested a bunch of turmeric pills on the market and found that one had no turmeric, basically, and others had more than even advertised. And they have found similar variations in echinacea supplements and elderberry supplements. Consumer labs found that more than two-thirds of elderberry supplements sold on Amazon did not contain authentic elderberry at all. This is true of every supplement. Well, maybe not every, but I can't think of a single supplement that Kazumer Lab has investigated where it hasn't found wide variation. According to a 2017 study, 20% of liver toxicity cases were tied to herbal and dietary supplements. 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. Marion says there are some supplements on the shelves that are maybe more trustworthy than oth ers. If they're marked with an N SF 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. And Marian thinks it is pretty important to point out that most supplements, whether they are certified or not, likely are not causing any real harm, even if they likely aren't causing any benefit. Some of them are harmful and that's a problem. But most of them are not particularly harmful. So there's a little risk , but I it's not a big risk. I mean, to be honest, that kind of surprised me. I mean, Marion Nessel, woman of science, you would think, would be rapidly anti-supplement . Honestly, she's gonna like, do whatever you want, people. 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