What’s the Difference between a Nutraceutical and a Dietary Supplement?
Are you aware that the vast majority of dietary supplements that are consumed lack evidence that they are beneficial for you? Since about one-half of Americans take at least one dietary supplement a day, you probably don’t want to hear this this unwelcomed news and have already rejected my position because you’ve concluded that I believe supplements don’t work. Not true. What I said is that they “lack evidence”, which is a different story.
You only know if a supplement (or drug or medical device or anything else) has a health or medical benefit after it’s tested in healthy people or patients in clinical studies, not just in scientific laboratory studies. For example, we know that vitamin C has a clinical benefit in patients with scurvy because they get better after eating citrus fruit or taking vitamin C. We know that penicillin works because it cures bacterial infections in patients, and we know that cardiac pacemakers work because they regulate the heart rhythm in cardiac patients.
What is not well known and appreciated is that the vast majority of dietary supplements have not been clinically evaluated. For this reason we don’t know if they are beneficial, harmful or just neutral. For example, a huge segment of the supplement industry makes anti-oxidant claims for their products. The message, which most consumers buy into, is, “It’s an anti-oxidant and, therefore, it’s good for you.” Though the scientific data are impressive there are precious few clinical studies to support that anti-oxidant are clinically beneficial. In fact, at times they may even cause harm. But, I’m not a pessimist for I do believe dietary supplements can play an important role in the prevention and treatment of disease as well as maintain health in other ways. Commonly available supplements such as carnitine, magnesium, vitamin D, CoQ10, folic acid, garlic, alcohol and vitamin E( don’t rule this one out!), particularly in combination, offer tremendous promise in battling America’s number one killer, heart disease. Even in conditions you would not dream of, supplements offer hope. For example, a study at Vanderbilt University Medical Center showed that melatonin supplementation alleviates insomnia problems in children with autism as well as their families significantly reducing the stress of coping with this disease.
What then is a nutraceutical? It is a dietary supplement that, in a credible clinical study, is shown to have a beneficial effect. It’s a term that I coined and is now in many dictionaries including the standard Oxford English Dictionary which credits me for coining the term. I did this in order to create one simple word to insert into my proposal to Congress, The Nutraceutical Research and Education Act or NREA. The intent of the Act is to encourage companies to become nutraceutical ones by funding clinical studies on their products. It was introduced in Congress in 1999 by Representative Frank Pallone (www.fimdefelice.org) but failed to pass because of a lack of support from any segment of the nutritional community. Hopefully, someone soon will successfully carry the ball to persuade Congress to enact the Act soon.
Many you are now justifiably asking yourselves, “Okay, Dr. DeFelice, where does that leave us?” Well, there is good news that is, for puzzling reasons, seldom mentioned yet, in my extensive experience in clinical studies, I find it extremely important for you to know. It’s the placebo effect. Though there is little doubt that supplements, like most things in life, have the potential for harm, their safety track record, particularly when compared to pharmaceuticals, is quite impressive. If all the dietary supplements were removed from store shelves and replaced with FDA approved pharmaceuticals, free to purchase without a physician’s prescription, one-half of the American population would be in heaven or burning in hell and the other half hospitalized within six months.
The placebo effect is a powerful, unexplained psychological-clinical phenomenon that results in impressive positive therapeutic effects. The brain turns on its machinery and sends signals to key parts of the body to do their job that it thinks needs to be done. For example, under certain conditions such as pain, depression, anxiety and fatigue among others including neurologic diseases, a positive placebo response can be found in up to 50% of the patients!
If you believe that you are responding, even though it’s only a placebo effect, that’s a very good thing. In addition, though there may be no clinical studies to support it, the supplement you’re taking may also be effective adding to the placebo effect.
In conclusion, even while making the assumption that all dietary supplements are ineffective, the value of them as a national placebo is critical for American health.
I’ll have more on nutraceuticals on later posts.