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.” [http://www.badscience.net/2007/09/the-fishy-reckoning/]
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.
*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.” [http://atvb.ahajournals.org/cgi/content/full/28/6/1158]
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. [http://circ.ahajournals.org/cgi/content/full/117/6/823]
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.