More than two-thirds of Americans take dietary supplements. The vast majority of consumers – 84% –
are confident the products are safe and effective.
They should not be so trusting.
I'm a professor of pharmacy practice at the University of Connecticut. As described in my new article in the Annals of Pharmacotherapy, consumers take real risks if they use diet supplements not independently verified by reputable outside labs.
What are the risks?
Heavy metals, which are known to cause cancer, dementia and brittle bones, contaminate many diet supplements. One study of 121 products
revealed 5% of them surpassed the safe daily consumption limit for arsenic. Two percent had excess lead, cadmium and aluminum; and 1% had too much mercury. In June 2019, the Food and Drug Administration seized 300,000 dietary supplement bottles because their pills contained excessive lead levels.
Bacterial and fungal contamination in dietary supplements is not uncommon. In one assessment, researchers found bacteria in all 138 products they investigated. Toxic fungi were also in many of the supplements, and counts for numerous products exceeded the acceptable limits set by the United States Pharmacopeia. Fungal contamination of diet supplements has been linked to serious liver, intestinal and appendix damage.
From 2017-18, dozens were hospitalized with salmonella poisoning after ingesting kratom, a highly addictive natural opioid. Thirty-seven of the kratom products studied were contaminated.
Some dietary supplements contain drugs, yet the manufacturers don't disclose that information to consumers. Frequently, the concealed drugs are experimental and, in some cases, removed from the market because they're dangerous. Hundreds of weight-loss, sexual-dysfunction and muscle-building products are adulterated with inferior or harmful substances.
Sometimes, the herb you think you're buying contains little to no active ingredient. Occasionally, another herb is substituted.
The consequences for consumers are considerable.
When
manufacturers replaced the herb Stephania tetrandra with the herb Aristolochia fangchi in 2000, more than 100 patients developed severe kidney damage; 18 more got kidney or bladder cancer. Although the herb is now banned by the U.S., a 2014 investigation found Aristolochia fangchi in 20% of the Chinese herbal products sold on the internet.
In an
assessment of CBD products, only 12.5% of vaporization liquids, 25% of tinctures and 45% of oils contained the promised amount of CBD. In most cases they held far less. A few CBD products had enough THC to put the user in legal jeopardy of marijuana possession.
Embarrassed by a New York Attorney General's Office investigation suggesting widespread and fraudulent under-dosing of active ingredients in dietary supplements, CVS
pharmacies analyzed 1,400 products that it previously sold in its stores. Seven percent, or about 100 products, failed, resulting in updates to the supplement facts panel or removal of the product from shelves.
What should consumers do?The Dietary Supplement Health and Education Act of 1994 allows manufacturers to sell dietary supplements without providing proof of their quality to the FDA. Instead, it's up to the FDA to prove a product is unsafe and take it off the market. That's an incredibly tall order, and woefully inadequate. But it's unlikely to change.
In the meantime, I recommend that consumers should not purchase supplements without verification from one of three highly regarded independent laboratories: the aforementioned United States Pharmacopeia, NSF International and ConsumerLabs.com.
The United States Pharmacopeia is an organization that sets reference and quality standards for prescription medication and food in the U.S.; the NSF International is an independent group that assesses safety and risk for food, water and consumer products; and ConsumerLabs.com is a company started to verify product quality for consumers that are paying members.
These laboratories conduct an initial analysis and then perform periodic unannounced assessments of the products; those with the appropriate amount of active ingredient, and without contamination or adulteration, can put the United States Pharmacopeia, NSF and ConsumerLabs.com seals on their bottles. CVS announced that all products sold at its stores going forward will need to provide the company proof of quality. Other major retailers should follow suit.
Some manufacturers conduct quality testing and post certificates of analysis on their websites. But the autonomy of the laboratory, and its standards, are often not known. Sometimes, labs may select an inappropriate testing method, intentionally or unintentionally. Sometimes they perform the test incorrectly, or simply make up results.
Because the FDA can't fully protect you from quality issues in dietary supplements – at least not right now – you must protect yourself. Even if a celebrity or "health guru" recommends a product, that doesn't mean it's high-quality. Before you put any supplement into your body, demand proof.
This article was originally published by The Conversation and was written by C. Michael White.
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Pictured: A healthy practice?
Will your current friends still be with you after seven years?
Professor shares how many years a friendship must last before it'll become lifelong
Think of your best friend. How long have you known them? Growing up, children make friends and say they’ll be best friends forever. That’s where “BFF” came from, for crying out loud. But is the concept of the lifelong friend real? If so, how many years of friendship will have to bloom before a friendship goes the distance? Well, a Dutch study may have the answer to that last question.
Sociologist Gerald Mollenhorst and his team in the Netherlands did extensive research on friendships and made some interesting findings in his surveys and studies. Mollenhorst found that over half of your friendships will “shed” within seven years. However, the relationships that go past the seven-year mark tend to last. This led to the prevailing theory that most friendships lasting more than seven years would endure throughout a person’s lifetime.
In Mollenhorst’s findings, lifelong friendships seem to come down to one thing: reciprocal effort. The primary reason so many friendships form and fade within seven-year cycles has much to do with a person’s ages and life stages. A lot of people lose touch with elementary and high school friends because so many leave home to attend college. Work friends change when someone gets promoted or finds a better job in a different state. Some friends get married and have children, reducing one-on-one time together, and thus a friendship fades. It’s easy to lose friends, but naturally harder to keep them when you’re no longer in proximity.
Some people on Reddit even wonder if lifelong friendships are actually real or just a romanticized thought nowadays. However, older commenters showed that lifelong friendship is still possible:
“I met my friend on the first day of kindergarten. Maybe not the very first day, but within the first week. We were texting each other stupid memes just yesterday. This year we’ll both celebrate our 58th birthdays.”
“My oldest friend and I met when she was just 5 and I was 9. Next-door neighbors. We're now both over 60 and still talk weekly and visit at least twice a year.”
“I’m 55. I’ve just spent a weekend with friends I met 24 and 32 years ago respectively. I’m also still in touch with my penpal in the States. I was 15 when we started writing to each other.”
“My friends (3 of them) go back to my college days in my 20’s that I still talk to a minimum of once a week. I'm in my early 60s now.”
“We ebb and flow. Sometimes many years will pass as we go through different things and phases. Nobody gets buttsore if we aren’t in touch all the time. In our 50s we don’t try and argue or be petty like we did before. But I love them. I don’t need a weekly lunch to know that. I could make a call right now if I needed something. Same with them.”
Maintaining a friendship for life is never guaranteed, but there are ways, psychotherapists say, that can make a friendship last. It’s not easy, but for a friendship to last, both participants need to make room for patience and place greater weight on their similarities than on the differences that may develop over time. Along with that, it’s helpful to be tolerant of large distances and gaps of time between visits, too. It’s not easy, and it requires both people involved to be equally invested to keep the friendship alive and from becoming stagnant.
As tough as it sounds, it is still possible. You may be a fortunate person who can name several friends you’ve kept for over seven years or over seventy years. But if you’re not, every new friendship you make has the same chance and potential of being lifelong.