LureOfSupplements

The Lure of Dietary Supplements and Health Misinformation
The Biggest Issue in Professionalism Facing Exercise Physiologists Today
Danita Saunders, RD, LD

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The Night I Bought a Water Filter
Joe Schwarcz, Ph.D

It was a dark and stormy night. Really. There was a knock at the door. The well-dressed gentleman on my doorstep introduced himself and proceeded to ask me a rhetorical question: “Are you interested in good health?” For a moment I pondered putting an end to the encounter by saying, “No, I would rather e cold, hungry, and sick,” but I thought better of it. Why not let him have his say? I invited him in.

“I noticed you have a tap in your kitchen,” he began, quickly demonstrating his keen powers of observation. I admitted that we had, indeed, opted for a house with indoor plumbing, despite the health benefits we might have attained y carrying buckets of well water during the Canadian winter. “You don’t actually drink that water, do you?” he went on. As if admitting to a crime, I replied that not only did we drink the tap water, but we also gave it to the cat. This seemed to cause the man grave concern: “It has chemicals in it, you know.” I think he was a little taken aback that this bombshell didn’t immediately cause me to clutch my throat; he evidently decided that heavier artillery was needed. “Invisible chemicals,” he explained. By now I had a pretty good idea where he was going with this, but the time was not yet ripe for a lecture on why “chemical” isn’t a four-letter word.

“Would you like to see those invisible chemicals?” he asked. Before I had a chance to ask how anything invisible could be seen, he began unpacking some equipment from his briefcase. The equipment looked impressive. It turned out to be some sort of electrical device fitted with a pair of metal rods that looked like electrodes. Next he asked for a glass of water from my tap. He sniffed it, and, apparently convinced that the liquid was sufficiently toxic, proceeded to immerse the electrodes in it. Then, with a cry of “Watch this!” he plugged the device into a wall socket. Within 30 seconds the water started to turn cloudy, and within a minute it had formed a repulsive yellow scum. “You see!” the man cried triumphantly, implying that by passing an electrical current through the water he had scared those nasty chemicals out of solution. The toxins had been comfortably dissolved, it seems, until the fear of being electrocuted prompted a mass exodus.

Then came the coup de grace. He extracted the water filter from his bag and attached it to the tap. He proceeded to subject the filtered water to the same kind of electrocution as had been experienced by my “toxic-laden” tap water, but this time the results were dramatically different. There was no yellow sludge, because those invisible, noxious chemicals had been “filtered out.” Surely, the couple hundred dollars this miraculous filter cost was a small price to pay for my family’s health. But if I was still unconvinced, the salesman told me, he had lots of documentation to support his claim. Out came the newspaper clippings about the various dangers that lurked in tap water, including expert testimony on how chlorine had been used as a poison gas during World War I. Again he reached into his bag. I waited for him to pull out a gas mask -- I’d been wondering how he dared to confront a lethal water tap without suitable protection in the first place. But no, instead of a gas mask, he grabbed a bottle of ortho-tolidine. He informed me that this substance would reveal the presence of chlorine in water by turning yellow. Sure enough, my tap water contained chlorine.

Now the man asked me to place a couple of fingers in a fresh glass of tap water and wait a few minutes. He tested the water again with ortho-tolidine, and this time there was no telltale yellow color. The toxic chlorine, he insisted, had been absorbed into my body. Exactly the same process occurred, I was told, every time I took a shower. No need to give up showers, though: the filtered water had no chlorine residue, and he had a filter that would fit any shower. With this dramatic demo, my lesson in toxicology chemistry came to an end.

It wasn’t easy, but I bit my tongue and made it all the way through. I didn’t even react when the salesman talked about “soaring cancer rates,” bodies overburdened with toxins,” and “scientists brewing up deadly chemical mixes.” I resisted pointing out that the average life expectancy lengthens every year and that while some cancers are increasing, others are declining. I didn’t even mention that the introduction of water chlorination was probably the greatest public health advance in history. But now it was my turn. Time for me to give a little chemistry lesson.

I began by picking up the glass of yellowed, scummy tap water, the one in which those nasty chemicals were no longer invisible, and raising it to my lips. Before the salesman had a chance to stop what must have seemed like a suicide attempt, I downed the contents. At this point the poor man’s face turned the color of the liquid in the glass. He must have thought I was mad. But I knew that I wasn’t taking any risks; I’d figured out what was happening. The yellow sludge wasn’t coming from invisible chemicals that had been jolted out of solution. It was coming from one of the electrodes. Electrolysis is a commonly performed chemical procedure in which two electrodes are immersed in water and a current is passed between them. This causes water to break down into oxygen and hydrogen. But if one of the electrodes is made of iron, it reacts with water to form a precipitate of yellow iron hydroxide -- or rust.

So, all I was doing was drinking a little rust, just a form of iron supplement, I explained to the incredulous salesman. I decided to punctuate my little performance by taking his glass of filtered water, adding a few grains of salt, and subjecting it to a current. Within seconds the familiar yellow scum formed. The salesman watched in awe. What kind of magician was I? He was confused. I explained to him that the water conducts electricity only when it has ions dissolved in it, and his filter had removed these ions. Therefore, no scum. But when I added a little salt, electricity flowed through the water and allowed the iron electrode to rust. To prove my point, I replaced the iron electrode with an aluminum one and invited him to torture my tap water with his apparatus once again. Since this time he used no iron electrode, there was no scum.

Next we tackled the chlorine problem. I drew two glasses of tap water and placed them on the table. I inserted a couple of fingers in one and asked the salesman to hold the other. A few minutes later we tested each for chlorine content. Neither glass had any. Chlorine, I explained, evaporates. It goes into the air, not into the skin. I wasn’t sure how effective my arguments and demonstrations had been. The salesman pointed out that the scum had formed with tap water and not filtered water, so the filter had done something. I couldn’t argue with that logic.

Certainly, this was not the only occasion that I’d found myself listening to curious chemical stories and bewildering claims. The business of brining science to the public through books, newspaper, radio, and television tends to prompt requests for consultations. Over the last 20 years or so, an assortment of entrepreneurs has visited me at hoe or at my office either to solicit my opinion on a product or to entice me into a “can’t lose” business venture based on some miraculous cure-all. I’ve seen and heard everything: crystals, magnets, pyramids, countless dietary supplements, convoluted weight-reduction schemes, special oils, oxygenated liquids, deoxygenated liquids, odor remover, odor-producers, exotic juices, ionizing bracelets, herbal concoctions, antioxidants of every description, parasite killers, therapeutic glasses, foot deodorants, water magnetizers, blankets that heal, and charcoal-laden underwear that counters the effects of bean consumption.

By and large, the people I’ve met, and continue to meet, are well meaning and not out to defraud others. But they do share an unrealistic and overly simplistic view of the way the world works. They recklessly bandy about terms like “toxins,” “chemicals,” and “poison” while misguidedly revering “natural” substances. Most possess only the vaguest understanding of molecules, chemical reactions, and research methods. They have little appreciation of the power of the placebo or the confusion that can be created by undue reliance on anecdotal evidence. True, science does not have all the answers and scientists do make mistakes, but sticking to the scientific method is still our best shot at progress.

Much of my professional work attempts to demystify science -- to provide a few scientific glimpses into the workings of our complex world. I hope that by offering explanations for a variety of common phenomena, I can help others understand how the scientific method functions and, at the same time, lay down a solid foundation for critical thinking.

That, of course, was just what I had in mind as I met with the water-filter salesman. I could lead him to water, but could I make him drink it? My demos and explanations may have had some effect, because when I offered him a cup of coffee, he happily sipped it, despite the fact that it had been brewed with water from my tap. It was than that I decided I had tormented the poor soul enough and that I should reward him for sitting through my chemistry lecture. He just about fell off his chair when I said I would buy a filter. Of course, my decision had nothing to do with his irrelevant demonstrations. I had been contemplating purchasing a filter, anyway. These devices do remove a number of undesirable substances that escape municipal treatment trihalomethanes, for one. While chlorine unquestionably saves millions of lives by killing bacteria that can cause disease, we do pay a small price for using trihalomethanes, which are carcinogenic. Activated carbon filters remove these, as well as a variety of other pollutants. U.S. and Canadian water-quality-standards call for limiting trihalomethanes to 100 parts oer billion (ppb). Whereas the risk of drinking tap water is very small compared with other risks we face, it is easily reduced by using (and properly maintaining) a good filter. In addition, I believe that water tastes better when it is free of chlorine residues.

So, I wrote a check for the filter, gave my new friend a chemistry text, and hoped that he would reap some benefit from our visit. The night, I thought, had been dark and stormy for him in more ways than one. I watched through the window as he braved the weather and headed towards the next house. Then the man who was so worried about the chemicals in my tap water paused for a moment, reached into his pocket, pulled out a cigarette, and lit up (1).

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“If you can’t beat `em, join `em.” That is what I started out to believe. However, after five years as a dietician, I became bewildered by the responses of patients, friends and family members when they asked me nutrition or health-related questions. As they listened to my response, their eyes would glaze over and the initial hope I had detected was gone. Was it my delivery? Did I have bad breath? After working on my delivery and brushing my teeth regularly, I found I received the same response. In time I determined what the problem was. The truth about health and nutrition often times was just not much fun. It made sense. For the most part it was logical. Usually the truth did not support fads or products that promised miraculous results. The fact is: when it comes to the truth about how to stay well or become healthy, people did not want to know the truth. That was the conclusion I drew from those experiences.

Over time I learned to choose my battles wisely. I did not offer information unless I believed someone was going to harm him- or herself through the use of a particular product. I found a smoother, more diplomatic approach to questions, though on the inside I may have been seething that there were “low-lifes” out in the world trying to make money on the hopes of unknowing potential clients. In time, my clients began to listen. What remained in me, however, was a total distrust of anyone who did not support the western model of medicine. If there was not research behind a claim, I would state this up front and discuss the importance of research. At times, I would get into heated discussions with individuals who tried to sell me products that lacked scientific evidence backing up the claims being made. Instead of hating the message, I was learning to hate the messenger, and often times the messenger (the one selling the dietary supplement du jour) was earning more money than me. Being human, this often added to my anger and frustration.

<>As times passed, I have mellowed more and learned more. The story about the water filter salesman which opened this article points out one lesson in particular that we, as exercise physiologists, need to understand. Many of the individuals selling dietary supplements or other questionable health products believe in what they are doing. Because of this, it is with kindness and respect that we must teach, to try and lead individuals in the right directions. We have to chose our battles wisely, but we must speak up. And, while doing so, it is important to remember that we might be “walking all over” an individual’s belief system by contradicting the claims he or she make about a product. Often times, people will identify themselves strongly with a product they are trying to sell. Some products even use religious references to further the support of those selling and buying the products (2). As illogical as the claims may be, the individuals may have too much invested to listen. Again, chose your battles wisely.

When it comes to other health professionals or educators, we cannot hold back. In order to give science a credible face, we have to promote credibility among our own. It is important that we do not stand back and ignore misinformation from another healthcare professional, or from another individual with a science background of any kind. In fact, today, it is more important than ever before. Now, we have children growing up believing that TV is a good place for information, and many of those children are now teachers teaching our own children.

Interestingly, at a recent community wellness meeting in another state, a mandate was decided as to which group of individuals within the school district would sit down and plan for improved health for their children. “A mandate group consists of a student, school administrator, parent, teacher, representative from the food school authority and school board member sitting around a table and discussing cafeteria food. These are some of the ideas they came up with:

Someone insisted the food be based on the glycemic index.
Someone wanted ‘whole milk’ because her daughter “needs the fat” but wants to get rid of chocolate milk due to sugar content.
Someone insisted on only organic because their wife has breast cancer.
Someone suggested only bagels be sold as ‘a la carte.’
Someone explained the elementary nurse is selling (to staff only) ‘coral calcium’ supplements; AND recommended ‘red yeast’ to an elderly mother (of a staff member) who has high cholesterol; AND recommended a variety of supplements to “rev up the metabolism.”
Someone explained that some ‘elementary’ mothers wish to provide ‘Burger King’ lunch on their child’s birthday.
Someone shared the ‘rule at the elementary school lunch’ of which each student must eat at least 50% of their lunch or they have no recess.

Tell me, who on this ‘mandated’ team can answer these questions? All the above discussions actually happened!

A key point here is that with so much nutrition misinformation, this community wellness policy is set up to perpetuate it. This ‘mandated group’ without a mandated nutrition professional enabled the further breakdown of good, solid science (3).

Although this example speaks mainly to nutrition, the same scenario can be imagined in which coaches, gym and health teachers also join into the conversation, promoting dietary supplements to improve performance and advocate fitness related practices that are not helpful and, in fact, may be potentially harmful to students. Now, if this is how our teachers and parents are hoping to help out with our communities, who is going to undo the misinformation? Just like health itself, to raise enlightened and well-informed children, we need to start early with children. Unfortunately things are not going very well in this regard. Educated people are falling for misinformation and passing it on to our children. Maybe it is easier to believe what we hear than it is to analyze and understand.

As professionals in exercise physiology, we can play a very important role reducing misinformation. Involvement in community, at youth centers, at school boards, as guest speakers in health and gym class, we can teach children about critical thinking skills. We might not want to call them critical thinking skills, but we can teach kids how to think about information they hear from all sources. We can teach through example. We could take a favorite commercial and analyze it for correctness. We could also show through example how to stay healthy, by exercising and eating right.

On the flip side of that coin, we can teach the meaning of moderation. When a client asks, “Is this food good for me?” we can answer by discussing how small amounts of anything is okay, but how too much might be a problem. If our client states that exercise is not worth it because there is no way to fit the one hour in given everyday challenges, we can discuss smaller more manageable ways to get in exercise without lecturing, and we can get in there exercise with them.

Most importantly we need to speak up for common sense when one of our own is losing track of evidence-based practices. We need to pull our colleague aside and explain the problems we see in the choices being made. We need to explain that his or her behavior reflects badly on all of us. And if needed, we need to take action to remove the credentials of healthcare professionals who practice “bad medicine” for the sake of money above all else.

In very limitied cases, dietary supplements are helpful. Most of the time they are products that serves to enrich the individual selling the product. We heed to remember that we are the individuals our clients will be turning to for the truth. We need to listen critically to every health claim we hear, to avoid falling prey to smooth and glossy presentation aimed at getting us to spend our money.

As an ethically practicing exercise physiologist, we may miss out on big money opportunities available to those who chose to sell out. We will most likely struggle, wondering why our clients eyes glaze over when we do not give them the answer they want to hear. We will, however, have the respect of our colleagues. We will advance in our field surrounded by peers who get it. And, we will have the satisfaction of knowing that we stood up for truth and science, even when it may have meant sacrificing some quick money. In the long run, we will probably make a better income over the lifetime of our career than when going for the quick buck.

So, stick to your guns, listen to what your clients are saying to you and, where appropriate, correct it when you can. Set a good example as a healthcare professional, and practice with dignity and integrity. This will bring a more satisfying professional life than will be gained by selling out to dietary supplements and health misinformation.

References

Schwarcz, J. (2001) The Genie in the Bottle. Preface. W. H. Freeman & Company, New York, NY. Also available at: http://www.quackwatch.org/01QuackeryRelatedTopics/filter.html

The Master’s Miracle Corporate Website. Natural, Simple Solutions for a Healthier Body and Mind. Accessed April 11, 2005. www.themastersmiracles.com/corpo

Scorscia, M. (May 4, 2005) RE:[wmdpg] [CVand Wellness] ADA not helping us? Listserve posting on: Weight Management Dietetic Practice Group. http://www.wmdpg.org/protected/files/electronic_mailing_list.html

Other sources of credible information:
Quackwatch.org – Your Guide to Quackery, Health Fraud, and Intelligent Decisions. Operated by Stephen Barret, M.D. http://quackwatch.org/

Quackwatch.org – Interesting Websites. (helpful guides for credible information) http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed

American Society of Exercise Physiologist. JEPonline. http://www.asep.org/jeponline/JEPhome.htm

American Society of Exercise Physiologist. PEPonline. http://www.css.edu/user/tboone2/asep/FLDR/pro1a.html