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Don't Trust Advice from Dietary Supplement Retailers!

Stephen Barrett, M.D.

  Advice from retailers is a major factor in the sale of herbal and dietary supplement products. Laypersons (such as health-food-store clerks) who diagnose ailments or prescribe products from their stores are practicing medicine without a license—which is prohibited by state laws. "Prescribing" can also be construed as the unlawful practice of pharmacy.

Many investigation have shown that retailers routinely ignore   these laws. Government enforcement efforts, which are limited,   are directed primarily against manufacturers. Here are some of   the reports I have collected.

In 1976, Eric Faucher, a National Enquirer reporter,   visited 16 health-food stores in major American cities and complained   of afternoon fever, weight loss, insomnia, and fatigue-symptoms   that could indicate a serious disease such as cancer. Only one   salesperson told him to see a doctor. The rest prescribed various   supplements for such diagnoses as "high blood pressure,"  "imbalance of energy," and "hypoglycemia."  "One salesgirl was stumped by my symptoms," Faucher   reported, "so she called up her mother (the store owner)   who prescribed vitamin E without ever seeing me!" [1]

In 1980, Sheldon S. Stoffer, M.D., and three associates from   the Northland Thyroid Laboratory in Southfield, Michigan, described   what happened when several of their employees consulted a supervisor   or "nutritionist" at ten health-food stores. The investigators   stated that their goiter was being treated with thyroid hormone   and asked whether any of the store's products would help. All   ten retailers said yes. Two advised stopping the hormone treatment,   six advised taking kelp, two advised taking iodine tablets, two   advised using a raw-gland preparation containing thyroid, parathyroid,   pituitary and adrenal gland extracts, and one advised taking a   raw thyroid preparation. (Health-food-store products made from   animal glandular tissues are not legally permitted to contain   potent amounts of hormones. Some do, however, but they are not   reliable because the dosage is variable.) Other phony remedies   included turnip tops, parsnips, parsley, malt tablets, and vitamin   and mineral supplements [2].

In 1981, Julian DeVries, 76-year-old medical editor of the Arizona Star, visited a health-food store complaining of   weight loss, loss of appetite, insomnia, leg cramps at night and   psoriasis (a skin disorder). "Two young clerks sold me an   assortment of vitamins for $124.34 that, according to a doctor,   easily could have worsened the conditions I told them I had,"   DeVries reported. Instead of being referred to a physician for   diagnosis of his possibly serious symptoms, he was sold megadoses   of several vitamins; a product containing ginseng and an adrenal   substance; digestive enzyme tablets; an iron-and-molasses compound;   tryptophan tablets; skin cream containing vitamin E and PABA;   and a book that suggested a nutritional cure for almost every   ailment known to humans. The clerks said that their recommendations   were authoritative because they had taken a three-week course   in vitamin nutrition in which the book was used [3].

In 1983, researchers from the Columbus Monthly contacted   nine health-food stores in central Ohio, by phone or in person,   posing as women suffering from an undiagnosed eye condition, a   mother-to-be seeking nutrition information for her pregnancy,   a recent heart attack victim, and a would-be weightlifter seeking   to build muscles. They concluded that although the store clerks   appeared to be sincere, their advice was "like flipping a   coin." [4]

In 1983, three investigators from the American Council on Science   and Health made 105 inquiries by phone or in person at stores   in New York, New Jersey, and Connecticut. Asked about eye symptoms   characteristic of glaucoma, 12 retailers attempted to diagnose   the problem (all incorrectly) and seventeen out of 24 suggested   a wide variety of products for the investigator's "mother."   None recognized that urgent medical care was needed. Asked over   the telephone about sudden, unexplained 15-pound weight loss in   one month's time, 9 out of 17 recommended products sold in their   store; only seven suggested medical evaluation. Seven out of ten   stores carried "starch blockers" (bogus diet pills)   despite an FDA ban. Nine out of ten recommended bone meal and   dolomite, products considered hazardous because of contamination   with lead. Nine retailers made false claims of effectiveness for   bee pollen, and ten did so for RNA. The investigators concluded   that most health-food store clerks give advice that is irrational,   unsafe, and illegal [5].

In 1986, Claire Aigner, R.D. posed five similar questions to   ten health-food store proprietors in eastern Pennsylvania and   concluded that only 46% of the answers were correct [6].

In 1989, volunteers of the Consumer Health Education Council   telephoned 41 Houston-area health-food stores and asked to speak   with the person who provided nutritional advice. The callers explained   that they had a brother with AIDS who was seeking an effective   alternative treatment for HIV. The callers also explained that   the brother's wife was still having sex with her husband and was   seeking products that would reduce her risk of being infected,   or make it impossible. All 41 retailers offered products they   said could benefit the brother's immune system, improve the woman's   immunity, and protect her against harm from HIV. The recommended   products included vitamins (41 stores), vitamin C (38 stores),  "immune boosters" (38 stores), coenzyme Q10 (26 stores),   germanium (26 stores), lecithin (19 stores), ornithine and/or   arginine (9 stores), gamma-linolenic acid (7 stores), "raw   glandulars" (7 stores), hydrogen peroxide (5 stores), homeopathic   cell salts (5 stores), Bach flower remedies (4 stores), blue-green   algae (4 stores), cysteine (3 stores), and herbal baths (2 stores).   Thirty retailers said they carried products that would cure AIDS.   Not one recommended abstinence or use of a condom [7].

In 1991, Julia M. Haidet, a student at Kent State University,   made 30 phone calls to ten stores in Central Ohio for advice about   headaches, kidney stones, or abnormal thirst, dizziness, and fatigue.   She received no appropriate advice [8].

In 1993, armed with a hidden camera, "Inside Edition"   visited four health-food stores in New York City to ask whether   they carried anything for fatigue and headaches; blurred vision;   arthritis; shortness of breath of a "grandmother who just   had bypass surgery"; strengthening the immune system; improving   memory; and/or "cleansing the blood." Products were   recommended in response to every question. When asked for a product   that could help people with AIDS, one GNC store manager recommended   an amino acid product that he said was one of the store's top   sellers. He also said the product was supposed to "help block   the chemical inhibiting the growth of the virus" and did   not have the toxic side effects of AZT. When confronted later,   however, he denied recommending the product for AIDS.

In 1993, "CBS Evening News" showed: (a) a GNC clerk   recommending a vitamin product to prevent hair loss, (b) a Nature   Food Centres clerk endorsing a fish-oil product as an arthritis   cure, and (c) another retailer recommending "E, C, A, shark-oil   capsules, all of these things help" for cancer. The program   reported that CBS News had sent fifty vitamin and mineral products   to independent laboratories for analysis to see whether they contained   the amounts claimed on their labels. Many were found to contain   too little or too much. Michael Jacobson, Ph.D., executive director   of the Center for Science in the Public Interest, commented that   going into a health-food store "is like being the victim   of one hundred different snake oil salesmen." [9]

In 1993, FDA agents visited local health-food stores throughout   the United States, posing as prospective customers. The investigators   asked, "What do you sell to help high blood pressure?"  "Do you have anything to help fight infection or help my   immune system?" and/or "Do you have anything that works   on cancer?" Of 129 requests for information, 120 resulted   in recommendations of specific dietary supplements [10].

In 1994, Jennifer E. Pumphrey, a student at Kent State University,   inquired about ephedra-containing products at 10 randomly chosen   health-food stores in the Cleveland metropolitan area. In each   store she found an "energy booster" containing ephedra   and asked: "Do you think this works?" and "Is it   safe? Does it have any side effects?" At two stores she was   correctly told that the products were powerful and should not   be taken by people with high blood pressure. At the rest she was   told that the product had no side effects. Some said it was harmless   because it was herbal, natural, or "not a drug." Ephedra   contains a stimulant that is potentially dangerous for people   with high blood pressure [11].

Between 1985 and 1997, the late John Renner, M.D., a board   member of the National Council Against Health Fraud, sought advice   for health problems at more than a hundred health-food stores   in 20 states and the District of Columbia. In all but two stores,   he was advised to buy products. Renner also observed hundreds   of customers shopping at these stores. More than half asked for   advice about a health problem, and almost all questions led to   inappropriate advice.

In 1998, a researcher posing as the daughter of a patient with   metastatic breast cancer inquired at 40 health-food stores in   Oahu, Hawaii. After products to assist in metastatic breast cancer   care were mentioned and/or shown, if store personnel did not provide   any further information, the researcher asked: (a) How does the   product work? (b) Do you recommend any particular brand (if more   than one brand available)? (c) Could I write down some prices?   (d) How much of the product does my mother need to take per day?   (e) Can the product(s) be taken together with the medication my   mother is receiving from her physician? and (f) Is there anything   else you can recommend? Personnel in 36 of the stores recommended   one or more of 38 inappropriate products, the most common of which   were shark cartilage (recommended by 17) and essiac (recommended   by 8), and maitake mushrooms (recommended by 7). [12]

In 1999, a researcher asked employees at 12 stores  in Mississippi, Tennessee, and Alabama what they recommended for depression. All 12 recommended St. John's wort products, and none asked about whether the cutomer was seeing a healthcare professional. Analysis of the products found that two contained almost none of the presumed active ingredient and that the recommended dosages of the others would deliver a wide range of intake [13].

In 2004, a researchers posing as a     woman 8 weeks' pregnant masde 155 calls in the Phoneix area to ask retailers for recommendations for treatment of nausea/vomiting and migraines. They found that 89% of stores offered recommendations for nausea/vomiting and 82% provided recommendations for migraines. Ginger was the most recommended product for nausea/vomiting. Only 3.6% of respondents recommended correct usage, but failed to supply the correct dosage and duration. A total of 15 of 278 (5%) were for products contraindicated in pregnancy [14].

Similar findings have been reported by investigators in England   [15], New Zealand [16], and Canada [17-20 In one of the Canadian   studies, eight students told retailers at 34 stores that their   mother was suffering with breast cancer. The average cost of recommended   products was CN$58 per month. The recommendations included 33   different products, none of which was supported by evidence of   effectiveness. Only 11 employees (32%) asked whether the patient   was taking prescribed medication; three (9%) discussed the adverse   effects of the products, and eight (24%) pointed out that the   products might interact with prescribed drugs. Two employees suggested   that the products might cure the cancer, and one advised stopping   standard treatment with Tamoxifen because it was "poisonous."   [18] In another of the Canadian studies, investigators found that   22 out of 34 stores recommended kava kava despite the fact that   Health Canada had warned against its use [20].

Studies in Canada and New Zealand have  found that health food retailers were far more likely than pharmacists to give inappropriate advice. In Canada, All of 20 health food retailers but only 4 out of 38 pharmacies recommended dietary supplements and/or herbs for the treatment of high blood pressure and 14 of the health food retailers said that their products were superior or equal to medicinal drugs [21]. In another study, undergraduate students visited 192 health food stores and 56 pharmacies located across Canda. In about half of the stores they  asked whether a specific supplement would help to prevent a particular condition or enhance health in a particular way. In the rest of the stores, they asked for advice on particular health concerns.  They found that 88% of times that questions were asked in health food stores, the recommendations  were either unscientific (6%) or  poorly supported by the scientific literature (82%). This occurred for only 27% of visits to pharmacies. The percentage of visits that yielded advice considered accurate or fairly accurate was  68%  for pharmacies and 7% health food stores [22]. In New Zealand, 25 out of 26 health food retailers recommended products and did not refer the researchers to a medical practitioner; whereas 25 out of 26 pharmacists recommended an immediate visit to a medical practitioner [23].

10. Unsubstantiated Claims and Documented Health Hazards in the     Dietary Supplement Marketplace . Rockville MD: Food and Drug Administration,     June 1993.   

11. Pumphrey JE. Marketing of ephedra products in health food     stores. Nutrition Forum 12:33-34, 1995.   

12. Gotay CC, Dumitriu D. Health     food store recommendations for breast cancer patients . Archives     of Family Medicine 9:692-698, 2000.   

13. Glisson JK and others. Clinic at the health food store? Employee recommendations and product analysis . Pharmacotherapy 23:64-72, 2003.      

14. Health food stores' recommendations for nausea and migraines during pregnancy . Annals of Pharmacotherapy 39:274-279, 2005.   

15. Vickers AJ and others. Advice     given by health food shops: is it clinically safe ? Journal     Annals of Pharmacotherapy of the Royal College of Physicians 32:426-428, 1998.   

16. Healy B and others. Do     natural health food stores require regulation ? New Zealand     Medical Journal 115:U165, 2002.   

17. Calder J and others. Health     information provided by retail health food outlets . Canadian     Journal of Gastroenterology 14:767-771, 2000.   

18. Mills E, Ernst E, and others. Health     food store recommendations: Implications for breast cancer patients .     Breast Cancer Research 5:170-174, 2003.   

19. Mills E and others. Emerging     issues associated with HIV patients seeking advice from health     food stores . Canadian Journal of Public Health 94:363-366,     2003.   

20. Mills E. and others. Impact     of federal safety advisories on health food store advice .     General Internal Medicine 19:269-272, 2004.   

21. Koren G and others. Comparison of verbal claims for natural health products made by health food stores staff versus pharmacists in Ontario, Canada .       Canadian Clinical Journal of Pharmacology 13:2251-256, 2006.   

22. Advice on dietary supplements: a comparison of health food stores and pharmacies in Canada . Journal of the American College of Nutrition 28:   674, 2009.   

23. Sibers R and others. High blood pressure advice given by natural health food stores . New Zealand Medical Journal 122. 2009.         

24. 15 supplements ingredients to always avoid . Consumer Reports Web site July 27, 2016.         

25. Supplements can make you sick . Consumer Reports Web site, July 27, 2016.     

This article was revised on November 1, 2016.