Timothy Caulfield is a Canada Research Chair in health law and policy at the University of Alberta and author of Relax, Dammit! A User’s Guide to the Age of Anxiety.
Supplements have received a lot of attention over the past few years. Indeed, the supplement industry (which includes vitamins, minerals, probiotics, herbs and botanicals) is booming – in part because of claims that they can help prevent, treat, or, even, cure COVID-19. (That’s bollocks, but more on that in a bit.)
During the pandemic we’ve heard supplement endorsements from many prominent individuals, including podcaster Joe Rogan (IV vitamins infusions, no less, for his COVID), Gwyneth Paltrow (Goop brand vitamins, of course, for her long COVID), NFL star Aaron Rodgers (part of his Joe Rogan-inspired COVID recovery regime), and far-right radio show host and conspiracy theorist Alex Jones (for, well, everything).
There are also those within the health care community pushing supplements as a COVID cure. One controversial Texas doctor went so far as to suggest that vitamins are better than vaccines. (Bollocks to infinity.)
Of course, the multibillion-dollar supplement industry has long (always?) been completely disconnected from a science-based approach to health. Unless you have a clinically identified need or deficiency – and by that I mean a recommendation from a science-informed provider who uses validated testing approaches – there is little evidence of clear health benefits from most supplements. To be fair, legitimate debate and research continues around the value of some, such as vitamin D supplementation. We should keep an open mind and follow the results from good clinical studies.
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But as with so many health topics, the pandemic seems to have supercharged and further polarized the supplement discourse. Traditionally, supplements have largely been associated with alternative medicine practitioners and the wellness industries where the marketing of concepts like “it’s natural!” – a near meaningless conception – have allowed the industry to expand. Often this marketing includes the explicit or vague promise that supplements will “boost” your immune system (they won’t and you can’t), making them a perfect product for the pandemic era.
Over the past year, however, the supplement rhetoric has taken a dark and ideological turn. Increasingly, support for supplements has become part of the basket of beliefs that anti-vaccine and COVID deniers expect their community to endorse. For example, the website for America’s Frontline Doctors – a conservative group that pushes conspiracy theories and unproven therapies such as ivermectin and hydroxychloroquine – suggests it “make[s] sense” to use “over-the-counter supplements” instead of an “experimental new technology” (i.e., the highly effective and safe vaccines). Like with ivermectin and hydroxychloroquine, supplement use has become as much an ideological flag as a personal health strategy.
In addition to the political spin there is the reality that many prominent anti-vaccination advocates, such as the notorious doctor Joseph Mercola, make millions off the sale of supplements.
Yep, as is so often the case, the rise of supplements during the pandemic comes down to politics and money. As recently noted by Paul Krugman, “Snake oil peddlers, clearly, find consumers of right-wing news and punditry a valuable market for their wares.” And this includes the bundling of anti-vaccine conspiracy theories and magical thinking about supplements.
But might, despite all this confusing noise, supplements provide clinically meaningful help in the context of COVID? In short, nope. Last year the World Health Organization’s myth-busting website provided this succinct summary of the literature: “Vitamin and mineral supplements cannot cure COVID-19.”
Since then, research has continued but the conclusion hasn’t really changed. The National Institutes of Health (NIH) in the U.S. has a frequently updated document that looks at the science surrounding supplements and COVID-19. They examine everything from elderberry to melatonin to probiotics to zinc. While researchers suggest that some supplements might, one day, be helpful, the themes that emerge throughout the document are: “more research needed,” “results mixed,” “no evidence,” “data insufficient to support,” and “no relevant clinical trials.” All in all, deeply underwhelming. Not a single supplement was found to have a clear benefit. No ringing endorsements.
Moreover, the NIH document highlights numerous risks associated with many supplements, including the chance of known and unknown interactions with medications. Other studies have found that – despite being marketed as natural (which is meant to scan as meaning benign and safe) – many supplements can do grave harm.
A recent clinical trial published in the Journal of American Medical Association found that zinc and vitamin C were not an effective COVID treatment and that “more adverse effects (nausea, diarrhea, and stomach cramps) were reported in the supplement groups than in the usual care group.” In other words, the supplement therapy did more harm than good.
It also shouldn’t be forgotten that the supplement industry remains lightly regulated, despite calls for more oversight and the need for more evidence to support marketing claims. The stuff you buy at your local supplement store may not be produced through the use of good science or robust quality control methods. Indeed, studies have found that supplements can be contaminated with heavy metals, bacteria, and, even, pharmaceuticals.
What is most fascinating – and frustrating – about the current embrace of supplements is the Olympic-level mental gymnastics vaccine deniers must deploy to maintain their position. They reject vaccines, despite the existence of mountains of incredibly robust evidence, rigorous regulation and safety surveillance, standardized quality control, and the availability of independent and high-quality information to inform decisions. But, at the same time, they are enthusiastic proponents of unproven, poorly regulated, potentially harmful and misleadingly marketed supplements.
Is there a supplement for cognitive dissonance?
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