Ah, coffee. It's a good thing they've found it's good for people living with hepatitis C, as I wasn't about to give it up.
But what's in the cup? I like honey in my coffee -- but most of the stuff that tries to pass itself off as honey, ain't. I put a bit of milk in there too. Am I adding BSE (bovine spongiform encephalopathy or "mad cow disease"), antibiotics, hormones? And where did the coffee come from? At home, I can be pretty sure it's fair trade and organic, as that's what I get at the Park Slope Food Co-op. Can I trust the labels? Generally, I think the answer is yes -- despite the fear mongering -- but sadly, not always.
This year, New York State's Attorney General made a splash with the announcement that testing of dietary supplements showed that many did NOT have what the label claimed. At first, I was thrilled to see a new player taking on the role of consumer protection. To my surprise, however, it only used one test in its assessment, which seems a bit shady given that there are several commonly used.
Let's roll back. I started talking about food and then I switched gears to dietary supplements. Aren't all supplements untrustworthy and likely to kill you, if not just waste your money?
Foods include groceries, beverages and even crap like soft drinks (obesity-inducing wastes of money, in my humble view). Drugs are agents that the Food and Drug Administration (FDA) has determined show a benefit in curing or mitigating a specific disease or condition. Dietary supplements fall somewhere in between, and are regulated by the Dietary Supplement Health Education Act (DSHEA). Despite what you may have heard, they ARE regulated, both in their quality and insofar as a manufacturer can't just slap anything it wants to on their label.
There are some basics about the stuff we ingest that characterize each of these classes, and over which federal and state governments may exert regulatory control. The sad fact is that ANYTHING we ingest can be bad, including drugs.
Supplement companies are required by law to follow Good Manufacturing Practices (GMP); however, many don't. You can about how to read a supplement label here. Look for supplements marked GMP as one way to assure quality.
What is it? If the bottle says it is vitamin C or Harvoni or a soft drink, then that's what it should be. Vitamin C should have some form of vitamin C in it, whether defined as ascorbic acid, calcium ascorbate or another chelated form of vitamin C that is recognized as such. Harvoni should have two drugs in each tablet: sofosbuvir and ledipasvir. A soft drink should have its unique and protected recipe of carbonated water, caramel or other colorings, and oddball flavors and sweeteners that help to induce obesity and metabolic syndrome.
How much of it? If the label says 500 mg of vitamin C, then that's what it should have -- or more technically, what each tablet or capsule or milliliter (if a liquid form) should have ±5%, by law. Harvoni should have exactly 400 mg of sofosbuvir and 70 mg of ledipasvir. And the soft drink should have a full liter -- or whatever size it comes in -- of the crap in the recipe.
Cockroach eyelashes? Bits of fly, sneeze product, rat and mouse droppings? Cadmium or lead? Verboten! In an ideal world, this would be the case. The fact is, there are a variety of impurities that are LEGALLY permitted in supplements. However, these are allowed only in minuscule amounts. So, within the parameters of the law, the products we consume should be pure and, at the very least, not exceed federal limitations on contaminants.
Who to Trust?
As the guy who ran the New York Buyers' Club (NYBC), I am keenly aware of the need for high quality products. Besides, I've been using these products for YEARS to manage chronic hepatitis C infection. I have all my bloodwork, scans and so forth, underscoring the efficacy of my approach so far in not only limiting disease progression but also improving my liver function and lowering my viral load. So I feel confident on a very personal basis about what I'm ingesting.
But that's not good enough. Over the years, NYBC (and before that, Direct AIDS Alternative Information Resources [DAAIR]), has taken the opportunity to do our own testing, though this has been limited due to the cost of such tests.
What tests did the AG in New York use? It used a new kind of "barcoding" test that assesses the DNA of the product to assure that what is in the bottle is a particular herb or plant. They've been criticized for having used the test on some tinctures that won't contain DNA, since chemicals have been extracted with water, ethanol, methanol or glycerin.
On the one hand, barcoding serves as a good new test for a LOT of different products that contain single or blends of whole herbs or parts of planets (roots, leaves, seeds, bark). On the other hand, there are a number of tests that can be used to assure a product is good, including high performance liquid chromatography (HPLC) to get a signature of a compound (identity) and to infer its weight (potency); and others to measure contaminants such as pathogenic bacteria, fungi, or heavy metals like lead or cadmium (purity).
Companies that are reputable can provide a Certificate of Analysis that underscores the results of their own batch testing. The FDA DOES routinely test supplements, but most often it's the fly-by-night operations making check-out counter crap like "Hard All Nite" that are found to be contaminated with actual drugs, like sildenafil. (You may have heard of this drug by a brand name: Viagra.) In the private sector, Consumerlab does product testing and provides pretty comprehensive reports on the outcomes as well as good background information on the evidence for a particularly dietary supplement.
So, short of NYBC receiving a significant budget influx to do more testing, we'll have to rely on these less-than-adequate approaches to assuring quality safety. In the meantime, we can advocate strongly from a consumer's perspective for increased, honest and transparent testing by agencies such as the FDA. The FDA has the mandate to do so, and it makes sense for it both to do so and to publish the results immediately -- whether they are positive, negative or somewhere in between.
I rely on vendors NYBC has worked with over the years, and will keep enjoying that coffee, taking a few supplements and using medicines appropriately. For now, here's a few guidelines:
- Look for well-known brand names: Jarrow, Swanson, TwinLabs. They generally do a good job.
- Check out consumerlab.com for reports on particular products.
- Look for brands with the USP or NSF seal for GMP.
- Look for herbs and botanicals marked with the USDA Organic seal.
- Check the expiration date.
- Avoid supplements at the checkout counter -- the ones that advertise improved sexual activity or weight-loss. They're usually spiked with pharmaceutical drugs.
- See a practitioner like a naturopath or acupuncturist who is knowledgeable about HIV and trusted (and we can talk about that).
So caveat emptor and carpe diem!
George M. Carter is administrator for the New York Buyers' Club (NYBC) and founder/director of the Foundation for Integrative AIDS Research (FIAR). He has been undertaking systematic reviews and meta-analyses of various questions around integrative medicine and HIV with a team at the Mount Sinai School of Medicine.