Principle Healthcare and the Unfair Trading Regulations

July 3, 2009 at 9:17 pm (Business, Nutritionism, Principle Healthcare, Remedies, Supplements) (, , , , , , , , )

Following on from my previous post about vitamin pill entrepreneurs Principle Healthcare, I bring you details of a letter I wrote to the authorities regarding the Consumer Protection from Unfair Trading Regulations 2008. Some of the claims made on the website I have been investigating are staggering.#

One claim I noted was that for those finding it difficult to focus on a task: “unless you’re taking fish oil supplements or you’re eating an extraordinary amount of fatty fish, chances are those levels [of Omega 3] were too low”.

This is a remarkable claim to make – it implies that maintaining adequate levels of Omega 3 fatty acids requires a very large intake that is only achievable by shovelling down masses of oily fish or popping fish oil pills. One wonders how vegetarians cope… [Incidentally, there are about 220 million strict vegetarians in India, according to the Anthropological Survey of India. I wonder if they are all deficient in Omega 3 fatty acids and have difficulty focussing on tasks?]

As far as I am aware, the only decent trials that have been conducted into Omega 3 fatty acids and mental performance have been in children with DCD or ADHD. As Ben Goldacre wrote in September 2007: “Even now, for all this pretending, there still has never been a single controlled trial, even a cheap one, of omega-3 fish oil supplements in normal children.” []

Another was this: glucose tablets are, apparently, “A must for those with hectic busy schedules”. Really? Sugar pills are essential for those with hectic schedules? This sort of stuff beggars belief. There’s plenty more where that came from.

According to Principle Healthcare, Coenzyme Q10 is of benefit “to those exposed to pollution and stressful lifestyles” because it is an antioxidant. Are antioxidants now a cure for stressful lifestyles? That sounds frankly bizarre to me.

Then there’s the assertion that homocysteine increases our risk of a problem with the circulatory system. I’m not sure whether there is any decent evidence to back up this assertion, but when I searched Pubmed for up to date evidence relating to homocysteine and the circulatory system I found only one paper with a link to free full text published in the last year. The conclusions of this paper did not seem to me to support the assertion made by the vitamin B pills salesmen. There is more on homocysteine as a surrogate endpoint below.*

As for Apple Cider Vinegar, well it almost sounds like a panacea. It “helps curb appetite, is a gentle detoxification agent, absorbs and blocks fat formation, boosts the immune system and supplies amino acids, minerals and vitamins”.


There’s a little bit more on ACV here: old blog post, please don’t laugh at my amateurish early efforts at blogging.

[Amendment: the text of the letter I wrote has been removed from this section.]

David Colquhoun discusses the Unfair Trading Regulations here. His post on whether most alternative medicine is illegal includes links to the relevant pieces of legislation.

Here are some PDFs of the relevant webpages just in case they disappear: Active Defence Apple Cider CoQ10 Echinacea glucose tabs Pomegranate Probiotic PHC About Us page PHC Ailments


*Homocysteine: is it a modifiable causal risk factor for vascular disease or simply a marker of risk burden? This is part of the background to this recent paper which found that “long-term homocysteine-lowering treatment with B-vitamins does not significantly reduce CIMT or increase FMD in people with a history of stroke” and that “the modest increase in FMD associated with short-term B-vitamin treatment does not appear to be translated into improved vascular structure or sustained in the longer term”.

As the authors state in the abstract, “long-term homocysteine-lowering did not significantly improve FMD or CIMT in people with a history of stroke” (CIMT is carotid intima-medial thickness and FMD stands for flow-mediated dilation).

A slightly older paper, meanwhile, concluded that “adjusting for renal function not only eliminates the relationship between tHcy and markers of vascular risk in subjects with proven cerebrovascular disease” and that “Our data are thus consistent with the hypothesis that mild renal impairment is an independent risk factor for vascular disease and elevated tHcy simply a marker for reduced GFR. The underlying relationship between tHcy and renal function is not altered by long-term B-vitamin supplementation and it is possible that, by treating homocysteine, we may be shooting the messenger rather than attacking the true risk factor.” []

A study that looked at biomarkers for PAD (Peripheral Arterial Disease) development in women did not find significant associations for homocysteine and other biomarkers. The authors “found the proinflammatory cellular adhesion molecule sICAM-1 to be the strongest predictor of confirmed clinical events” and noted three other biomarkers that were significant and one that was borderline significant. []

I’m not expert in medical matters (as you will probably have noted if you’ve read this blog before) but it seems to me that homocysteine could well be a false surrogate endpoint.

Edit, 28th April: homocysteine April 2010 (PDF on a trial of B vitamins in lowering homocysteine in patients with diabetic nephropathy – no treatment benefit and demonstration of harm.)

#Edit 24th March: I now have a category for Principle Healthcare.


  1. dvnutrix said,

    As you know, Patrick Holford is enthusiastic about homocysteine. I will (yet again) quote the fine advice from Vasan.

    Regardless of the purpose for its use, a new biomarker will be of clinical value only if it is accurate, it is reproducibly obtained in a standardized fashion, it is acceptable to the patient, it is easy to interpret by clinicians, it has high sensitivity and high specificity for the outcome it is expected to identify, it explains a reasonable proportion of the outcome independent of established predictors consistently in multiple studies, and there are data to suggest that knowledge of biomarker levels changes management.

    Vasan RS. (2006) Biomarkers of cardiovascular disease: molecular basis and practical considerations. Circulation 113: 2335-2362

    As you point out, although it is possible to modify Hcy levels through various interventions, there is, as yet, no strong indication that this reduction results in a clinically relevant reduction in morbidity, let alone mortality.

  2. Neuroskeptic said,

    “As for Apple Cider Vinegar, well it almost sounds like a panacea.”

    To be fair it is quite tasty although I prefer sherry vinegar when I can afford it. But out of the three cheap ones you can get in the Co-Op (white wine, red wine, apple cider), apple cider is the best.

  3. jdc325 said,

    @Neuroskeptic: I think taste is perhaps a better reason to purchase Apple Cider Vinegar. Which is another reason why buying capsules and tablets seems to me to be a waste.

  4. jdc325 said,

    @dvnutrix: thank you for the Vasan quote & link. I remember reading Greehalgh on surrogate end points but I haven’t got round to reading the full text of the Vasan paper yet.


    In a veiled slight on surrogate end points, Sackett and his team remind us that the choice of specific treatment should be determined by evidence of what does work and not on what seems to work or ought to work.

  5. Astgtciv said,

    “I do not believe that pomegranate provides a significant amount of vitamin C or iron.”

    Why don’t you think pomegranate provides a significant amount of vitamin C?
    One whole pomegranate contains 48% of the RDA for vitamin C.

  6. jdc325 said,

    Gah, sloppiness on my part there. You’re absolutely right that a whole pomegranate contains a significant amount of vitamin C. Thanks for pointing this out.

    I doubt that the pills I was referring to do, though, contain a significant amount of vitamin C. Note that the serving that contains 48% of the RDA for vit C is 282 grams. Principle Healthcare’s product contains 200 milligrams of Pomoegranate – an amount that is less than one thousandth of the serving referred to on the website you link to. I reckon that would mean that the pills would provide about 0.03% of the RDA for vitamin C if the composition of the extract is comparable to the composition of pomegranate.

  7. vitamin+health said,


    Vitamins and health
    1. Introduction. What are vitamins?

    Vitamins are known to us for over 100 years. They have written and said quite a lot. But what are vitamins? What are they different from other biologically active substances? Once upon a time there were more than two dozen, but now vitamins include all 13 compounds. At the same time, there are the so-called “vitaminopodobnye substance.” What are they different from the vitamins? Let’s start with the definition of “vitamins.”

    Vitamins – essential organic substances necessary to sustain the vital functions of the organism involved in the regulation of biochemical and physiological processes, biomolecules with a predominantly regulatory functions entering the body with food, “” indispensable (essential) food substances which do not occur in formed in the body or not enough. ”

    Admin edit: I have removed the commercial link in the url section of the comment, but left the text of this comment as I enjoyed the reference to vitamins having “written and said quite a lot”. I also wondered if any readers could shed light on a word that is new to me: vitaminopodobnye? I’d guess that it’s an English-Polish hybrid word provided by a struggling translation service. The attempted link at the bottom of the comment did not include a “href” attribute, so while it looks like a link it doesn’t actually point anywhere.

  8. Principle Healthcare and « Don't Get Fooled Again said,

    […] (2) Unprincipled Healthcare: Part Two. […]

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