Knowing how to compare labels is a big factor in keeping supplement sales in-house. Over half the U.S. population buys and takes supplements, according to a national survey. Another half read labels, while only one-fourth get past the ingredients.
Author and TV personality Dr. Art Ulene, advocate of what he terms the “vitamin revolution,” says people will reject a product if they don’t like what it says on the label.
As supplements become more popular, availability and competition are increasing. “The Label Reader’s Pocket Dictionary” confirms that more and more people are buying supplements, even in supermarkets. Yet most do not have a defined standard to compare “apples to apples.”
As a doctor dispensing supplements and other therapeutic remedies, chances are in today’s changing regulatory environment, you will eventually be called upon to defend your data and your decisions. What exactly do you say to patients who tell you they can get the “exact same thing” you provide in your clinic from a local health-food store or cut-rate chain – and get it for less? The answer is on the label.
When patients buy supplements from you rather than a retail store, they are also buying your expertise and judgment. That is one important reason you should carry product lines available only through health-care professionals, not available over the counter. The more well-versed you are about the content of the nutritional products you carry, the more you protect your bottom line.
Rules, Regs and RDAs
Designations for nutrition can be like wading in alphabet soup unless you examine their intent. Says New York Times nutrition columnist Jane Brody, “nothing about micronutrients is more mysterious to the average consumer than these government-promulgated abbreviations.”
RDAs (Recommended Dietary Allowances) are derived by nutritional scientists who advise The Food and Nutrition Board (a committee of the National Academy of Sciences-National Research Council). Updated every five years, RDAs denote daily nutrients adequate for maintaining health. They are not nutritional requirements, or treatments (except for deficiencies), and do not cover special needs.
“The biggest problem with RDAs is how to translate the numbers, so they apply to what you put in your mouth,” Brody says.
In their popular handbook for patients and practitioners, “Let’s Play Doctor,” Drs. J.D. Wallach and Ma Lan point out: “Food supplements at RDA levels are better than nothing but will not prevent serious disease (i.e., arthritis, osteoporosis, arteriosclerosis, etc.). Preventive doses of vitamins and minerals are fairly well-established, which are quite a bit higher than RDAs but not in the megavitamin range.”
Scientific research on the subject is incomplete. And official requirements for many nutrients have not yet been established.
USRDAs (United States Recom-mended Daily Allowances) are derived from RDAs. USRDAs were developed as a reference for nutrition adequacy created by government scientists. These are levels of essential nutrients ex-pressed in percentages, thought to prevent serious deficiencies such as rickets, scurvy and beri beri, for the majority of people.
DVs stand for Daily Values based on 2,000 calories (questionable considering so many low-cal diets). Created by FDA, DVs combine RDIs (Reference Daily Intakes, which are recommended limits to promote optimal long-term health, replacing the old USRDAs) and DRVs (Daily Reference Values referring to food components such as fat, cholesterol, sodium, etc., which have been linked to certain chronic diseases). RDIs are basically identical to the old RDAs, according to the “Nutrition Desk Reference.”
The ‘Pill Bill,’ Etc.
A compromise version of the Nutrition Labeling and Education Act passed in 1994, the “Pill Bill” kept the supplement industry in turmoil for several years. The bill empowers the Food and Drug Administration (FDA) to bar health claims on labels of nutritional supplements and herbals unless there is “significant scientific agreement” to substantiate the claim. For example, no cancer-fighting claims can be made for Vitamin C until these capabilities are proven in the laboratory.
However, supplement manufacturers can state on the label how the products “affect a structure or function of the body” such as Vitamin A’s role in achieving good eye sight. This fine line between claims and function is still being debated.
The act also establishes safety standards for claims, requiring the caveat that statements made have not been evaluated by the FDA, and the product is not intended to diagnose, treat, cure or prevent disease.
Because FDA works with less rigid guidelines for pre-market reviews of supplements than for other products in its jurisdiction, “consumers and manufacturers, not the government, are responsible for checking the safety of dietary supplements and determining the truthfulness of label claims,” author Dr. H. Winter Griffith says in his book “Vitamins, Herbs, Minerals & Sup- plements.”
Under the Modernization Act of 1997, manufacturers are permitted to use claims based on current, published, authoritative statements from NIH (National Institutes of Health), CDC (Centers for Disease Control and Prevention), the Surgeon General, the Food and Safety Inspection Service and the Agricultural Research Service within the Department of Agriculture.
“Make reading labels a habit, even if you have to use a magnifying lens,” Brody says in “Nutrition Book.” Reading labels can “also help determine whether we’re getting our money’s worth when we choose one product over another,” she says. Top health-care centers, such as the renowned Cooper Clinic in Dallas, encourage nutrition patients to compare labels.
Vitamin companies are mandated to include on current labels:
- contents in net quantity;
- structure or function;
- directions for use;
- a “Supplement Facts Panel” (serving size and amount of ingredients);
- ingredients in descending order (RDAs or DVs first, other ingredients second, with largest quantities listed before smallest); and
- and identification (name/address) of the manufacturer, distributor or packer.
“Labe ls can tell you a lot if you know how to read them,” Brody says.There are certain things a label isn’t allowed to say, including: the presence of a certain nutrient or lack of it is useful in prevention, treatment or cure of disease; claims about ingredients having no significant value; natural being better than synthetic; superior because it is organically grown; and superior because it has fewer additives.
Capsules vs. Tablets
You can discern from the label how well the supplement will dissolve in the digestive system and be absorbed into the bloodstream. A product should ideally break up in one hour. If it doesn’t, and not all supplements do, its effect is diminished accordingly. It is not uncommon, for example, to see non-dissolved tablets (compressed too hard) on patient X-rays.
By comparison, capsules dissolve more quickly than tablets, thus absorb faster, especially for sick people with poor digestion. Capsules can also improve patient compliance, because they can be opened for use in drinks or on food.
Dr. Bert Hanicke, professor of anatomy and X-ray at Logan College, says he prefers capsules over tablets for muscle-testing techniques. Capsules work well because you can “just sprinkle a little on their tongue,” Hanicke says. “They don’t have to bite through a tablet.”
Never has the market been so conducive to nutrition sales in the chiropractic office. Recent statistics show 56% of supplement purchases are doctor- recommended, 31% come from books and magazines, and 19% are recommended by friends or relatives.
Even the explosion of media attention is in your favor. Surveys show two out of three people take supplements to maintain health, and seven out of 10 for wellness and prevention. Knowing how to interpret your labels can turn inquiries into revenues.
Clearly the message today is “ask your doctor.” As a portal-of-entry caregiver, you are the first logical place for patients to turn for therapeutic potencies based on individual needs. Think of it as saving your patients time, money and potentially disappointing results if they experiment on their own with unknown brands, strengths and combinations.
Even an official statement from the American Institute of Nutrition and American Society for Clinical Nutrition says supplementing is best done under a doctor’s supervision.
Know Your Ingredients
In a current national research study of supplement users, 59% chose a manufacturer they could trust as the single most important point in deciding product preference; more important even than price. Not only is it preferable to work directly with a manufacturer rather than a distributor, which gives you more control over product quality, but imperative to choose a company selling only to doctors and health practitioners, which better ensures reli-able results.
“Know your ingredients,” says Dr. James Balch’s book “Prescription for Nutritional Healing.” (Aspartame is in some multi-vitamins, for example.) And know what’s behind the name. The label represents responsibility to perform.
Not all ingredients are created equal. “When you consider price, keep in mind not only the number but also the amount of nutrient in each. Don’t let the sizedeceive you; the quantity of a given vitamin or mineral can differ considerably,” Ulene says.
One of the best examples of comparing “apples to apples” is a recent letter from a chiropractor to his manufacturing source about a patient who had found in one of the largest discount chains in America, a so-called identical product to one offered in the doctor’s office – at a lesser price. After evaluating labels side-by-side, the manufacturer proved the products were not the same, and the cut-rate item was actually more expensive. The patient was getting short-changed. Some simple arithmetic reveals how:
- Price. The store brand contained 60 tablets at $14.97 for a 20-day supply of three per day. At $22 per bottle, the manufacturer’s 60 fill contained a 30-day supply of two per day. At 75 cents/day for 20 days vs. 74 cents/day for 30 days, the doctor’s product was still the better buy.
- Ingredients. The store brand listed 1,500 mg of glucosamine HCl per three tablets, for a total of 30,000 mg per bottle. The manufacturer had 750 mg per capsule, or 45,000 mg total. The store brand listed 1,200 mg of chondroitin per three tablets, or 24,000 mg total; the manufacturer, 250 mg each or 30,000 mg per bottle; a difference of 1,500 mg. The key factor is proportion. Clinical research has proven a three-to-one ratio gives superior therapeutic results, which the manufacturer provided. The store brand did not, thus the patient was literally being deprived of chondroitin. In addition, Vitamin C had been added to the manufacturer’s product, because clinical evidence proved it to be an effective catalyst. No Vitamin C was in the store brand.
- Dosage. The most common errors in comparing products are the fill and the dosage needed to meet label potency. On first glance, you would assume the store-brand potency was per one tablet, rather than three. Only the manufacturer measured potency on a per-one basis.
Labeling It Positive
Ultimately the objective is offering your patients the most comprehensive service you can. Understanding label language is a step toward that commitment, while also improving your profit margins.
A pioneer in putting human values in the world of science, famed professor and physician Sir William Osler sum-med it up: “The secret of caring for the patient is caring for the patient.”