I have previously written about the benefits and risks of herbal traditional Chinese medicine (TCM). I focussed specifically on the way in which the National Institute of Complementary Medicine (NICM) put the publics’ mind at ease regarding TCM by simply misleading them. The main goal of the NICM is to convince the public that the pre-scientific ideas that “explain” the theory behind TCM is valid, that TCM is an effective medical treatment for a whole range of conditions and due to the strict Australian regulations that TCM and complementary medicine (CM) in general is safe to use. The motivation for doing this seems to be financial with the main objective to use Australians as guinea pigs in order to expand the $170 billion TCM market into the West.
The dangers of herbal TCM have been well documented and reports of quality control issues continue to make headlines. Recently a study reported that DNA of the highly endangered snow leopard, and possibly tiger, was identified in an herbal TCM product. This particular TCM is a regulated (AustL) product for sale in Australia. The danger to people but also wildlife is real – the Rhino poaching statistics in southern Africa indicates that this is indeed a serious and growing problem. The question remains; can the quality of herbal TCM be controlled?
However, this article is not about the problems experienced with TCM – it is about what the West is sending back to China. The Chinese milk scandal in 2008 resulted in an insatiable appetite in China for infant formula produced in Western countries. Many Australian companies used this tragedy in China to start their own lines of infant formula for export to China. In principle, nothing wrong with this, as long as the infant formula contain what it should contain. Although breastfeeding is obviously better, there are times that this is not an option and thus high quality infant formula might be called an essential. The effect on the price and availability of infant formula was however felt all over the western world. However, with the infant formula something else made the journey to China – vitamins and supplements.
The NICM conducts stability tests according to TGA guidelines on a commercial basis for the vitamin/supplement industry in Australia. These products are being sold legally and as such there is nothing wrong with the NICM’s involvement. Their commercial laboratory adheres to the TGA guidelines and although they receive very little support from the NICM executive (most resources are being spent on lobbying) they are doing a good job under difficult conditions. The main problem however is the conflict of interest. The NICM is also involved with research into the beneficial effects of these vitamins/supplements and the question can be asked; will they report unbiased research results when the income of their commercial laboratory depends on it? And will they defend vitamins/supplements when negative results are published?
As Chinese companies are trying to expand their herbal TCM market (facilitated by institutes such as the NICM) into western countries, companies in western countries are expanding their markets, piggy backing on the milk scandal, into China. A lot has been said about the lack of efficacy and potential dangers of vitamins and supplements. An editorial in a high quality scientific journal simply said “Enough is enough: stop wasting money on vitamin and mineral supplements”. They conclude “….supplementing the diet of well-nourished adults with (most) mineral or vitamin supplements has no clear benefit and might even be harmful. These vitamins should not be used for chronic disease prevention. Enough is enough.”
There has always been a heated debate regarding the benefits of taking extra vitamins and research usually gives mixed results. Obviously there are unique circumstances where vitamins are beneficial e.g. if you plan to circumnavigate the globe and you don’t want to die of scurvy, you might want to consider taking either fresh fruits or a bit of extra Vitamin C. Other than unique circumstances and people suffering from very specific medical conditions, or pregnant women, supplements should generally be avoided. Thus very few people in western countries need extra supplements – but what about China? (I’ll come to that a bit later).
The risks of taking extra vitamins include increased rates of cancer, and recently a study reported that the mineral supplement trivalent chromium is converted into the carcinogenic hexavalent chromium. The dangers of hexavalent chromium were illustrated in the well known book and movie – Erin Brockovich. The dangers of taking non-vitamin/mineral supplements are also well known as was recently again demonstrated by reports of multiple organ failures. Taking extra supplements or not is a hotly debated subject. I personally tend to lean towards the side that suggests not taking any extra vitamins if you do not fall into one of those special groups. For non-vitamin supplements, I would suggest not to take any at all. The reason why I have this view is the following.
There is another potential risk with taking extra vitamins/supplements that is somewhat understated. I once saw a television advertisement where a specific vitamin was directly compared to be the equivalent of eating a number of apples. As the well known saying goes; an apple a day keeps the doctor away. Another method of marketing is to pay well known TV personalities or sports stars a handy fee to endorse these products. Comparing their products with food and in combination with the unreserved VIP endorsement of these products, the public will now start to believe that taking these supplements is better than food. After all, most products have been “clinically proven” and these stars are beautiful, successful, healthy people so surely it works!
Another approach is to create and sell products for people who lead an “active” lifestyle because in modern times we don’t have much time on our hands. That the average Australian spends about one month per year watching TV is irrelevant! It is however a lot easier and quicker to take a supplement, for people on the go, than preparing a time consuming balanced meal for yourself and for your kids. Skip breakfast, pop a pill and drink a liquid breakfast while you are on your way to work/school – the latter obviously coming from the food industry. Here we have a substitute for a balanced diet.
Another issue is that the CM industry tends to shift the focus of any negative attention on other industries in order to protect or increase the sales of their own products. That they always refer to the problems experienced in the pharmaceutical industry, to hide their own problems, is well known. But now they have also started to refer to the issues in the food industry, such as high sugar/fat/salt content, in order to convince the public that their products are all natural and thus better. That the food industry has their problems that urgently need to be solved is without doubt. The main problem with this comparison is that food is essential, for self explanatory reasons, and a balanced diet simply means that that we need to be careful with what we eat. Sugar is not bad for you, it is actually essential, but too much of it is bad. On the other hand extra vitamins are not essential for the biggest part of the population whilst most of the non-vitamin supplements are nonessential for anyone.
The problem can be explained by using an analogy first used by Donald Rumsfeld. We know that a specific food item contain specific essential nutrients such as vitamins. We have identified them, studied them and we know what role they play – too little or too much can lead to disease. And hence a balanced diet is required. This is called the known knowns. But we also know that food contain other compounds and nutrients which have been identified, but the exact role that they play is ill-defined or unknown (known unknowns). There is however a third group and this aspect has been overlooked thus far. Specific food items might contain unknown compounds or nutrients and because they are unknown it is also unknown if they play any role – it is unknown (unknown unknowns). The problem is thus, as soon as you isolate a single nutrient or compound from a food item (or they are synthetically produced like most vitamins) you only focus on the known knowns and any other potential beneficial components are ignored. If consumers start to use these vitamins/supplements as a substitute for food then we might be running into some serious trouble. A parallel can be drawn with homeopathy. It is not always what you take (e.g. vitamins) that might cause you harm but what you don’t take (e.g. deficiency in the known unknowns and the unknown unknowns).
It is well known that western countries have seen a marked increase in the incidence of a number of diseases including obesity, allergies, cancer etc. It is however quite interesting to note that migrants from low incidence countries acquire these western diseases quite quickly. This observation is currently explained by the “hygiene hypothesis” whilst others suggest that endocrine disrupting substances might be to blame. However, our sedentary lifestyles and overconsumption of highly processed foods are currently seen as the main culprits. This is however a complex issue and multiple factors, all of the above and more, might play a role. But the question can now be asked; can replacing, partially or fully, a balanced meal with quick fix vitamins/supplements be causally linked to the increase in the incidence of these diseases?
This will be an extremely interesting scientific study and only time will tell. For example; 10 or 20 years ago the average person might have supplemented their balanced diets whereas today, due to clever marketing, these supplements have started to replace our balanced diets. Nevertheless the jury is still out on the benefits/risks of extra vitamin supplements whilst the benefits of non-vitamin supplements are negligible, whereas the risks of some might be quite severe.
The TCM export market is blooming but so is the Australian export market to China. Both export articles (excluding infant formula) suffers from a lack of benefit and suffers from several risks. In a previous blog I discussed the regulatory environment in Australia and that the CM industry only adheres to the second level of regulations – to a degree. The Australian manufacturers can tell you exactly what and how much of it is in their products (eg. Vit C), the size of the capsule, colour, disintegration rates etc. and this is being sold to the Chinese as proof that their products are of high quality. For many people this implies that these products from Australia are highly beneficial and that there are no associated risks. But in Australia, the first level of regulations – benefits and risks – are not adhered too. Anyone can put almost anything into a capsule as long as you stick to the second level of regulations.
Whilst the NICM is facilitating the import of TCM products, by using Australia as a thoroughfare into the western markets, they are also supporting the export of supplements into the lucrative Chinese market. At the end of the day the world revolves around money and the CM export to China has brought a lot of quick profits for a number of individuals and the shareholders of a number of these companies. Some of these profits flow back into Australian universities where the “evidence” for CM is being produced. The NICM recently received a $400 000 scholarship and a $1.3 million research chair was also established at another university. Wouldn’t it be excellent if the hypothesis that I’ve stated in this article could be investigated by either a PhD student at the NICM or by the new research chair? But then again looking at the NICM’s track record, or complementary medicine researchers in general, the results are already known beforehand.
The Chinese government should be very careful when it comes to supplements imported from Australia and other western countries. A full risk-benefit analysis of all the imported supplements and investigation of different hypotheses, such as the one stated in this article, should be done. A balanced diet and physical exercise remains to be the two most important aspects for general health.
Any comments welcome!