The headline in the May 8th Washington Post was typical: “When it comes to vitamin supplements, more isn’t always better.” The writer went on to explain that megadoses of various vitamins were worthless, and possibly dangerous, and brought in the questionable practice of intravenous vitamin injections, generally damning the “immensely profitable vitamin industry” with a wide and careless brush.
The headlines the Post could have written?
“Nearly a third, 31 percent, of African Americans don’t get enough vitamin D.”
“American women, 20 to 49, border on insufficiency for iodine.”
“More than one-in-ten Latino children are low on iron.”
And they could have attributed all of those headlines to the Centers for Disease Control report on global nutrition and not employed a freelance writer who had her own book and a nutrition communications company to promote. Still, while questioning whether the Washington Post and mainstream media is telling the wrong story remains a frequent but futile exercise for the supplement industry, the better question might be why the industry isn’t telling its own story better.
Healthy profits?
Profit obviously breeds complacency. The “if it ain’t broke …” adage holds true across any number of business models and it certainly applies to the supplement industry, where high margins are common and growth eclipses other industries even in the “bad” years. Automobile sales hit a record high last year, but were only up .4 percent, while growth in supplement sales is considered unspectacular at 6 percent. In this case, however, profit almost breeds complicity. Nutrition in the United States is surely “broke,” and it’s not easy to point to a notable effort in the nutrition industry to fix American nutrition at the most basic levels.
To be clear, market penetration is high. According to a Council for Responsible Nutrition survey, 175 million Americans take supplements. The industry sold$12.7 billion worth of vitamins and $2.9 billion in minerals. Vitamin sales grew 4.5 percent to probiotic’s 17.1 percent, but again, 4.5 percent is a lot better than the automobile industry’s .4 percent. Minerals grew 4.
Still, is the industry meeting its mission? Huge numbers of Americans remain poorly nourished.
Nobody expects the industry to go altogether altruistic, but the question remains whether a focus on innovation and a “what’s new?” mentality moves the industry toward the oft-stated goal of “transforming healthcare.” Is disease-based medicine going to be turned around with a new delivery format? Higher bioavailability doesn’t matter much when the nutrient isn’t available to the populations that most need it. Condition-specific products offer legitimate solutions, but too many products look like they are creating a need rather than meeting one.
In the end, all the differentiation and innovation may have companies overlooking the gateway supplements of vitamins and minerals, teaching whole generations to think about conditions and solutions rather than the basic foundation of good nutrition.
Defensive crouch
The industry could also be accused of playing a game of continuous defense. A spiked sports supplement scandal will hit the front page, and industry spokespeople will explain that DSHEA defines dietary supplements and Product X is clearly not in that definition. A pundit will call the industry unregulated, and the industry response will detail the many checks and measures imposed by the FDA.
Such defenses are worthy and warranted, but it can seem like the only time the industry’s voice gets heard is when it’s defending itself. “If the sky is falling, people will show up,” says Dan Fabricant, executive director at the Natural Products Association.
Author and integrative practitioner Dr. Teiraona Low Dog sees the same thing. Instead of pushing a message of basic nutrition and pointing out the startling deficiencies, “they are too busy defending DMAA and all the other things they get involved in.”
The same plot arc holds true when the headlines come from scientific journals. A study finding that an ingredient offers no benefit, or instead causes harm, will always be more likely to land on the front page than a positive study. The industry has to respond to those headlines too.
But constantly responding to crises builds a very different relationship with the press than the industry needs.
Why aren’t the startling nutrient deficiencies from the CDC reports provided to reporters the next time a wave of headlines reports on childhood obesity or any number of conditions with an obvious nutritional link? The media talks endlessly about the excess fat grams and calories in fast food, but the nutrients missing from those foods are rarely discussed.
And nobody talks about what happens when those nutrients go missing
A Google search for “Campaign for Essential Nutrients,” a project funded by DSM and other ingredient suppliers to boost awareness of micronutrient needs, garners a whopping nine news mentions over two years, and none of them in mainstream publications.
Taking the test
What’s missing from the messaging, says Low Dog and others, is a combination of information and urgency. Most Americans believe the days of rickets and scurvy are ancient artifacts, and indeed fortification programs have eliminated the most obvious and striking effects of nutrient deficiencies. But you can still find headlines like “Scurvy is a serious health problem” and “Rickets soar as children stay indoors” in the first-world, and even less dramatic effects go unnoticed or unstudied. “I think there’s a complacency that sets in when you kind of live in a bubble,” Low Dog says. “Because we’re not seeing these frank deficiencies, we’ve sort of suspected that we’re getting what we need from food.”
The everything-from-food mantra gained volume in late 2013, when the Annals of Internal Medicine published an editorial declaring “Stop Wasting Money on Vitamin and Mineral Supplements,” despite the fact that the editorial drew from three studies published in the issue that came nowhere close to finding vitamin and mineral supplements worthless. In the following months, frequent critic Dr. Paul Offit made the rounds of morning news programs and daytime talk shows promoting his book, Do You Believe in Magic, which include a diatribe echoing the Annals of Internal Medicine editorial.
The assumption that food supplies all essential nutrients at sufficient levels got a different boost in recent years by increasing awareness, and increasing sales, of natural and organic food. In 2015 NBJ consumer research, the idea that food met all nutritional needs was the number one reason people gave up buying supplements.
But, as in many nutrition-related instances, what you don’t know can hurt you.
Organic or not, food can’t necessarily supply enough nutrients if it’s not getting enough nutrients from the soil. That connection between poor soil conditions and supplements has yet to hit the mainstream media and few are talking about how selective breeding and hybridization (even before anybody brings in genetic modified) have created fruits and vegetables that are bigger, but not necessarily better.
More than anything, the get-everything-from-food idea is based on the fallacy that people would even know if their nutritional needs were being met, by food or supplements. Karen Howard, executive director at the Organic and Natural Health Association (O&N), calls knowable nutrient levels “the missing link” in the case for nutrition.
O&N, partnering with Grassroots Health, is sponsoring a Power of Nutrients project that launched with test kits for vitamin D and is adding in Omega 3. More nutrients, including magnesium and choline, will be added to the targeted selection, all with the aim of proving the health benefits of basic nutrients based on large population studies. Grassroots Health started distributing vitamin D test kits seven years ago and has data on more than 12,000 participants. With that data, the industry will be able to tell the story it needs to tell, Howard says. “Nobody has put the pieces together to create a rational and documented story associated with solid supplementation,” she explains.
An exceedingly small number of people know their nutrient levels, Low Dog observes, and when many consumers read a headline about low vitamin D, they could easily see that as something that happens to other people. Doctors aren’t ordering the tests, and in many states ,consumers are not allowed to order their own. “Why do you have to guess what your vitamin D level is?” asks Low Dog. “You wouldn’t guess what your cholesterol is. You wouldn’t guess what your blood pressure is. You would just check it.”
The political play
With the better data that Howard’s organization seeks to gather, the industry might be in a stronger position to lobby for policy changes that would make supplementation a more expected and accepted piece of nutrition, and make nutrition a more important component in healthcare.
One of the main goals in that quest has always been modifying the federal Supplemental Nutrition Assistance Program (SNAP) to let recipients spend their food stamp dollars on multivitamins. WIC, the Women Infants and Children version of SNAP for pregnant women and mothers of small children has been another target. SNAP funds can be spent on a wider range of grocery items that can include snacks and soda. WIC is more restrictive.
But neither can be used to pay for multivitamins.
That may be ready to change.
Mike Greene, CRN’s vice president for government relations, says the landscape has never been more favorable for moving supplements into the acceptable purchase column for SNAP and WIC. The Farm Bill is up for renewal in 2018, and the current political atmosphere is widely accepted as friendly to the supplement industry. More importantly, Greene says, trade associations can come armed with better arguments that supplements can reduce healthcare costs and improve student performance. Supplements can be portrayed as part of a plan to get people off food stamps—healthier people may perform better in school and find better opportunities. “I know congress is aware of this,” Greene says. “We have seen this information coming out of various government agencies.”
“There is an enormous amount of momentum that wasn’t around ten years ago,” Greene adds.
Fabricant notes that some of that momentum has already brought results. A recent appropriations bill included funds to study the benefits of including multivitamins in WIC. Fabricant believes there is already “very good data,” but government reports have gravitas that provides a level of acceptance the industry has never been able to claim. “What happens with WIC is they measure outcomes, they measure micronutrient status,” Fabricant says. “Are we going to see higher test scores and things like that? I think we will.”
Even with that data, Fabricant believes getting multivitamins into WIC and SNAP will still take a different kind of lobbying than the industry has been able to muster in recent years. Conventional food lobbyists could see it as a “zero-sum game.” “If you’re coming in, that means somebody is going out,” Fabricant says. “It’s literally a huge food fight. People are going to dig in.”
Fabricant believes the industry could better organize at a grassroots level. NPA is doing grassroots outreach, but the industry as a whole has not gotten behind it the way it could. “We’re in the thousands,” he says. “But we should be in the hundreds of thousands.” He points to efforts to allow consumers to spend their Health Savings Accounts dollars on supplements. “That bill has been introduced in three separate congresses, but again, where is the groundswell?”
By the ledger
In the end, the case for nutrition, if it is going to have that “transforming healthcare” effect, is going to have to be made on a balance sheet. Health Business Strategies founder Michael Levin says politicians are not going to matter nearly as much as insurance companies. “Who’s the customer for this?” Levin asks. “It’s the policy people, the payers.”
Supplements are a cost until the savings are proven. The O&N testing program is aimed at quantifying that return on investment argument, but Howard cautions that it will take time. The vitamin D test project has been underway through Grassroots Health for seven years. The omega-3 component is brand new.
Levin believes waiting for data may not be the answer. He can think of one study that “connected the dots” between nutrients and economic outcomes, and it got “no traction,” he says.
What Levin says he would like to see is a health plan that offered a “try this first” option. As Levin describes it, an insurance company would have a formulary of natural alternatives or a selection of conditions that a patient could take without a co-pay. If the alternative didn’t work, the patient could move to a pharmaceutical drug and pay the out-of-pocket costs. If a patient tried an alternative for just three months, or even one prescription cycle, the insurance company could save hundreds of dollars. “You can build a mathematical model to show it very compellingly,” Levin says.
Others have recommended approaching major corporations. Wellness programs are already common at big companies. Levin has worked with one at a 3,000-person firm. He hopes to be able to show companies that supplement use can reduce absenteeism. That approach offers results an executive can see right in the office. “It’s not easy,” Levin says. “But it’s doable.”
On message, on shelf
A trip to the nearest mall might suggest that Americans have never heard that eating healthy is important. Wallowing between the Big and Tall outlet and the Orange Julius, the masses seem to grow more massive, and less healthy, with every headline. At the same time, in the bookstore just down from the food court, half the magazines on the rack at Barnes & Noble will have some variation of a “killer abs” headline on the cover.
So a message is getting out, but it might not be one that’s coming from the supplement industry.
Americans have an obsession with macronutrients, and the micronutrients are easily forgotten. Grams of protein, carbohydrates and fat are in bold type. Micronutrients get a passing mention if they’re mentioned at all. Diets become centered on the number of calories and the kind of calories, but rarely the “right calories.”
For Twinlab CEO Naomi Whittel, making the case for nutrition comes down to meeting customers where they are. That can mean an age demographic, a lifestyle segment, anything that helps consumers make a connection between their health and their goals. “It’s finding the groups that need to hear that information,” Whittel says.
Athletes need to hear about how their workouts deplete their nutrients. Older adults need to hear which nutrients help their bodies guard against infirmities. Video game enthusiasts might respond to information about lutein and the ravage of blue light. Once you connect an individual to a group, you have a better chance of explaining the likely nutrient deficiencies, Whittel contends. That army of video gamers informed of the impact all those hours have on their eyes might listen to Whittel’s observation that, “we, on average, need to consume two bowls of spinach every day just to get the minimum amount of lutein.”
Twinlab is taking that idea to the front lines in the effort to get attention, testing nutrient levels for Vitamin Shoppe employees so they can communicate the urgency. A live person, standing in the aisle, explaining the realities can be powerful, Whittel says. “When you get tested, then you really know the answer.”
Nutrition accomplished
Society has much to gain from optimum nutrition. A nation of sick and tired people costs the economy far more than the $3 trillion in healthcare. With better nutrition, people could feel better, get sick less often, work more effectively and pursue more opportunities.
Howard can see O&N’s testing campaign paying off with benefits far beyond selling more supplements. “I think the real change, in ten years, is that the way healthcare is delivered will move from a disease-based system to actually looking at ways to prevent disease,” she says.
It sounds ambitious, lofty, unachievable in the Supersize Me era, but that may not be the case. Low Dog points to seatbelt use as an example of how quickly attitudes can change. Until the early 1980s, seatbelts were used by a small percentage of drivers. People either didn’t care or clung to oft-repeated, but rarely documented, stories about people being trapped in their car while it was engulfed in flames. It took a change in the law to change the behavior, but the safety aspect was accepted almost instantly. Nobody talks about the fiery death myth anymore. Instead, they put on their seat belts, and they know those seatbelts save lives. The law may not even be the main factor that drove seat belt use from 14 percent in 1983 to 87 percent 20 years later. People don’t expect to get in an accident every time they get in a car, but they wear their seatbelts because they know it’s safer over time. Basic nutrition isn’t so different.
“Taking a basic multivitamin,” Low Dog says, “is like wearing a seatbelt.”
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