puritan's
The Puritan’s Pride website has a Vitamin Advisor that claims to provide a personalized supplement plan, with expert recommendations chosen just for you. In my opinion it is deceptive, designed not to provide evidence-based personalized health advice, but to sell their products; and one can only wonder what kind of “experts” would support such ill-advised recommendations. Stephen Barrett and I have just co-authored an article on the Quackwatch site analyzing the Vitamin Advisor’s advice. I wanted to share what we found with our SBM readers, with some further comments.

Their recommendations are based on a series of questions like age, sex, health concerns, whether you are exposed to cigarette smoke, etc. The full list can be found in our Quackwatch article. The one-size-fits-all questions are useless because “eye concerns” might mean anything from needing glasses to glaucoma.

$100 worth of stuff I don’t need

I filled out the questionnaire honestly, and it advised I take these 6 products (links are to SBM posts on these topics):

  1. UltraWoman 50 Plus Multivitamins
  2. CoQ10 100 mg
  3. Omega fish oil 1000 mg
  4. Absorb calcium 1200 mg with vitamin D 1000 IU
  5. Triple strength glucosamine, chondroitin, MSM Joint Soother
  6. Vitamin D 2000 IU

The total price of these six products is $99.90. In my informed opinion, this advice is wrong. There is no credible scientific evidence that I would benefit from any of these. Dr. Barrett was also advised to take six products, none of which he needed. I stopped taking multivitamins many years ago and explained my reasoning why.

My Puritan’s Pride Vitamin Advisor recommendations add up to a total of 8000 IU vitamin D and 2044 mg of calcium. The tolerable upper intake level of vitamin D is 4000 IU; of calcium, 2000 mg. For women my age, the recommended amount (from all sources) is 800 IU of vitamin D and 1200 mg of calcium. The benefits of calcium and vitamin D supplementation remain uncertain, and calcium supplementation has been associated with increased cardiovascular risks.

Deciphering the algorithm

Dr. Barrett and I were curious, so we had fun doing a little detective work. We tried putting different answers into the questionnaire, posing as a man or woman of various ages. The algorithm it uses was easy to figure out:

  • If you are a teenager, it asks no further questions and recommends Mega Vita Min Multivitamins for Teenagers
  • EVERYONE gets a multivitamin: If you are a woman under 50, you get UltraWoman; if you are over 50 you get Ultrawoman 50 Plus; if you are trying to get pregnant, you get Pre-Natal Complex
  • If a woman checks poor emotional wellbeing, she gets UltraWoman, B-50, Omega, vitamin D
  • If you are tired, you get vitamin B12 1000 mg
  • If you are a woman with PMS: B-50 complex, magnesium, calcium/D
  • If you are a woman with menopausal symptoms: B-50 vitamin complex, Estrobalance, and magnesium (Estrobalance contains phytonutrients found in soy and black cohosh, vitamins and minerals including E, folic acid and calcium)
  • Eye concerns: lutein/zeaxanthin
  • Joint concerns: glucosamine/chondroitin/MSM
  • Air pollution: Vitamin C, selenium 200 mcg, vitamin E 400 IU
  • Cigarette smoke exposure: Vitamin C with bioflavonoids and rose hips
  • Urinary tract concerns: Cranberry fruit concentrate with C and E
  • Stress, tired, poor emotional well-being: Vitamin B complex, vitamin C/bioflavonoids/rose hips, vitamin B12 1000 mcg, omega, vitamin D
  • Digestive concerns: Probiotic 10
  • Blood sugar concerns: Cinnamon/chromium, magnesium
  • No sun exposure: Vitamin D 2000 IU
  • If you’re a vegetarian: B12, fish oil, calcium/D
  • If you’re concerned about heart health and BP: CoQ10, omega fish oil 1000 mg, magnesium 250 mg
  • If you have concerns about bone density: Calcium/D, magnesium 250 mg, and an additional vitamin D pill with 2000 IU
  • If you are a man who wakes up to urinate during the night, you get a saw palmetto product

In our judgment, none of these recommendations are based on good scientific evidence. You can read our critique of each recommendation, explaining why we thought it was wrong.

Who needs supplements?

Obviously, customers would not consult a Vitamin Advisor unless they were already convinced they needed supplements. But most people don’t need supplements; their nutritional needs are met by their diet. If it can be determined that their diet is inadequate, the obvious remedy is to improve the diet. Taking pills is a poor second best, and money spent on supplements could be better spent on healthy foods. Many people take a multivitamin out of insecurity, as “insurance” to allay their fears that they may not be eating right. Others take them in the false belief that they will improve their energy or for other reasons that are not supported by evidence.

In most cases a multivitamin is harmless, even though it may accomplish nothing more than creating expensive urine. But every vitamin and mineral can be harmful in high doses. There is growing concern that taking high doses of antioxidant supplements such as beta-carotene might do more harm than good. You may remember how Gary Null almost killed himself with his own brand of supplement that happened to be inadvertently overloaded with vitamin D. And there is even some evidence that a daily multivitamin is associated with an increased rate of death in older people. (Admittedly, this is correlation, not causation; a causal link has not been established.)

According to The Medical Letter, 47 (1213):

Supplements are necessary to assure adequate intake of folic acid in young women and possibly of vitamins D and B12 in the elderly. There is no convincing evidence that taking supplements of vitamin C prevents any disease except scurvy. Women should not take vitamin A supplements during pregnancy or after menopause. No one should take high dose beta carotene supplements. A balanced diet rich in fruits and vegetables may be safer than taking vitamin supplements. No biologically active substance taken for a long term can be assumed to be free of risk.

According to the American Academy of Family Physicians at the time I wrote my SBM article about multivitamins:

The decision to provide special dietary intervention or nutrient supplementation must be on an individual basis using the family physician’s best judgment based on evidence of benefit as well as lack of harmful effects. Megadoses of certain vitamins and minerals have been proven to be harmful.

Their current advice about vitamin and mineral supplementation for various specific indications either recommends against supplementation or states there is insufficient evidence to assess the balance of benefits and harms.

The disclaimers

And while poor diet might be a rationale for vitamin and mineral supplements, most of the diet supplements on the market are not intended to supply dietary deficiencies but to provide some kind of alleged preventive or therapeutic effects. Under the DSHEA, sellers are not allowed to make claims about such effects. Puritan’s Pride includes the usual disclaimer, and they comply with FDA regulations by only mentioning vague function/support claims. For example, for the lutein/zexanthin supplement that they recommend for everyone with “eye concerns,” they say:

Lutein helps to improve vision in low contrast situations, which is essential for night driving. Lutein Lutigold™ plays a role in the maintenance of eye health and is the principal Carotenoid found in the central area of the retina called the macula. Carotenoids are fat-soluble antioxidants found in fruits, vegetables, marigolds and other plants.…Nutrients such as lutein, zeaxanthan, and EPA may support eye health.

For eye health, in addition to the lutein/zeaxanthin supplement recommended by the Vitamin Advisor, the company sells 35 other products to support healthy eyes, including various combinations of antioxidants, some of which contain up to 25,000 IU of beta carotene. The Medical Letter has said no one should take high doses of beta carotene.

The only evidence-based use of supplements for eye health is that a specific mixture has been shown to slow the progression of moderate-to-advanced macular degeneration. Puritan’s Pride does not sell this mixture. There is no evidence that supplements offer any benefit for prevention of macular degeneration or for treatment of early disease, and there is no evidence that they benefit any other eye conditions.

Stephen Barrett “translated” Puritan’s Pride’s disclaimer thusly:

We’d like to sell you products, so here is a questionnaire that will recommend something no matter how you answer it. Our information is not necessarily derived from sources that are trustworthy or even relevant to humans. When ingredients are included in more than one product, the combined amounts can exceed safe levels, but our recommendations won’t take this into account. We would like you to believe that our products are useful. However, our words are not intended to suggest that they can help treat, cure, or prevent any disease. They are merely “informational.” We say that you should not consume any product we recommend without discussing it with your doctor. However, we really don’t mean this, because most doctors will advise you not to take the products. We just say it as part of our effort to avoid legal responsibility for any harm caused by our advice or products.

Conclusion: Puritan’s Pride wants your money, not your health

Most people don’t need vitamin supplements. There are specific indications for supplementation in specific circumstances. All women who might become pregnant should take a folic acid supplement. Otherwise, it is best to consult a doctor who can provide truly individualized advice based on detailed knowledge about the patient. Relying on an online questionnaire for medical advice is foolhardy. Your physician wants to do what’s best for your health; the Puritan’s Pride company wants to sell you stuff. Buyer beware!

 

 

Posted by Harriet Hall

Harriet Hall, MD also known as The SkepDoc, is a retired family physician who writes about pseudoscience and questionable medical practices. She received her BA and MD from the University of Washington, did her internship in the Air Force (the second female ever to do so),  and was the first female graduate of the Air Force family practice residency at Eglin Air Force Base. During a long career as an Air Force physician, she held various positions from flight surgeon to DBMS (Director of Base Medical Services) and did everything from delivering babies to taking the controls of a B-52. She retired with the rank of Colonel.  In 2008 she published her memoirs, Women Aren't Supposed to Fly.

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