Karina Basso Associate Editor
Academics and medical professionals acknowledge the benefits of dietary supplements—at least some of them— and many physicians even recommend them. Nonetheless, the dietary supplement industry is often rapped for offering new products before there is much scientific evidence to show they’re safe and efficacious. Indeed, few manufacturers are willing to sponsor clinical studies to find such evidence. And that’s understandable. Not only are the studies costly, but publicizing the results could benefit their competitors. While academics face the same study costs, they don’t have to justify their work in business terms, and they don’t need to meet the fickle desires of consumers. They’re only interested in assessing the medical value of dietary supplements, which include a variety of botanical substances.
William Folk is a researcher at the University of Missouri in Columbia, MO. He said more research on dietary supplements is sorely needed. “More than half of the American public uses dietary supplements, but there is so little information about these products, and they are not well regulated. However, many scientists complain that studying dietary supplements is a total waste of time and say we should be spending money on drug design and developing new drugs and their targets.”
That hasn’t stopped Folk and other botanical researchers from doing their work. “We are well recognized and respected by the experts in our field,” said Richard van Breemen, director of the Center for Botanical Dietary Supplements Research at the University of Illinois in Chicago. He said more collaboration with the dietary supplement industry would be beneficial. “If dietary supplement manufacturers can put on their labels that they invested in studies that provide evidence of their products’ safety and efficacy, I think it would help them sell more and it would ultimately benefit the consumers.”
Guilio Maria Pasinetti is the director of the Center for Molecular Integrative Neuroresilience, New York, NY, which studies how botanical dietary supplements can reduce stress-induced psychological impairments, such as mood and neurodegenerative disorders. “In my opinion, as much as 60 percent of nutraceuticals on the market don’t fulfill the public’s expectations,” he said. “I’m concerned that many companies that sell nutraceuticals make health claims that are not backed by rigorous scientific investigation. We want to provide background and evidence on dietary supplements to reassure the public what is really going on inside the field of the research and not to simply trust what is printed on the bottle.”
Potential Balms for Stress, Other Maladies
Pasinetti’s research focuses on polyphenols—natural substances found in grapes—and how they affect the human microbiome. “Basically our guts’ microbes have the capacity to metabolize these polyphenols and generate bioactive polyphenol metabolites. Once we understand the mechanism of action, we may be able to generate some kind of probiotic to promote activity of these microbes and promote the body’s resistance to psychological stress and cognitive decline.”
The potential is great, but the possible drawbacks are, too. “As researchers, we have to ask ourselves that if active polyphenol metabolites are doing something good here in the gut, are they doing something harmful somewhere else? Is there a cancellation effect? Is there synergism?” Van Breemen is also concerned about how drug products and botanicals interact. He and his team at the University of Illinois are researching hops and licorice, which have estrogenic properties that can relieve menopausal symptoms and may slow the progress of cancer, heart disease, dementia, Alzheimer’s disease, and diabetes. “We are currently looking at hops from a safety perspective in a clinical trial and testing for possible interactions with common drugs. If they are going to influence drug metabolism of common prescription medications, that has to be known in advance.” He noted that St. John’s wort, a nutraceutical used to treat mild depression, reduces the effectiveness of beta blockers and statins.
Folk of the University of Missouri said that even botanicals that have been used for centuries should be assessed for safety and possible negative interactions. Because they have only recently been used in combination with modern medicines, the mixtures may be dangerous. He and his colleagues are studying Sutherlandia, a botanical native to southern Africa purported to boost the immune system and prevent infection. “As a result of our clinical trials with Sutherlandia, we discovered that this plant and perhaps other medicinal plants may interfere with a tuberculosis treatment used worldwide,” Folk said. “About a third of the world’s population is latently infected with tuberculosis and are at risk for active infection, so it’s a huge concern if a popular dietary supplement makes that treatment less effective.”
Bridging the Gap
While dietary supplements have many potential benefits, there isn’t a lot of money available to determine their true efficacy. Folk noted that the US National Institute of Health’s annual budget exceeds $30 billion, while the National Center for Complementary and Integrative Health, the branch charged with studying botanicals and dietary supplements, is allotted a small fraction of that budget, slightly more than $100 million1,2. Nonetheless, he says, “I’m in full support of having a competitive process where the strongest work gets funded. It’s the only way that good research can advance.”
Because there isn’t much governmental funding, manufacturers of dietary supplements and pharmaceuticals should invest more, van Breemen said. “Botanical dietary supplements are in some ways a return to the origins of folk medicine, natural botany, and inexpensive accessible medicines that are available to a great many people in the world, especially in Third World populations,” he said. “I would like to see nutraceutical businesses invest more in research. I guess the trick for them is they don’t want to invest in research that could benefit their competitors.”
Another problem, Folk said, is technology transfer and information sharing. “A lot of basic research is never acted upon by the public or medical professionals. I’d like to see more contact between the nutraceutical industry, doctors, and researchers to advance public health, but it is a matter of time and each side is tackling a very different set of problems.”
Pasinetti said consumers also play a role. “When you want to buy a car, you don’t just enter a car dealership and buy the first car you see. Most buyers do extremely detailed research, using the Kelly Blue Book, looking at performance reviews, researching where the cars are made, and if this is indeed the make and model they want. They should spend the same amount of time when buying and checking out nutraceuticals.
References
1. NIH What We Do: Budget. Online. Accessed March 16, 2017.
2. NCCIH Funding: Appropriations History. Online. Accessed March 16, 2017. Center for Molecular Integrative Neuroresilience, New York, NY. Tel. 212 241 5563 Website: www.icahn.mssm.edu UIC Botanical Center, Chicago, IL. Tel. 312 996 4960 www.pharmacy.uic.edu Center for Botanical Interaction Studies, Columbia, MO. Tel. 573 884 9770 www.mizzouadvantage.missori.edu