Puritan's Pride's "Vitamin Advisor"
Wants to Sell You Something
Harriet A. Hall, M.D.
Stephen Barrett, M.D.
Puritan's Pride, which is one of the world's leading mail-order marketers of dietary supplements, would like you to believe that its "Vitamin Advisor" provides a "personalized supplement plan" with "expert recommendations chosen just for you." The "experts" are not identified, but the program is licensed from Healthnotes, a company that markets "decision tools" that promote product sales. Healthnotes was founded more than 15 years ago by chiropractor named Skye Lininger. It states that its online Vitamin Advisor "has proven itself to be a sales machine" with "add-to-cart rates 2x over the industry average."  The "personalized" recommendations are generated by an interactive questionnaire. On the Puritan's Pride Web site, everyone is asked:
- Your age group: 13-18, 19-49, 50-plus?
- Male or female?
- What are your health concerns? Heart health, blood sugar, eyes, joints, urinary tract, blood pressure?
- Do you have any digestive health concerns?
- Any personal or family history of hip fracture or low bone density?
- Are you regularly exposed to air pollution?
- Do you get at least 15 minutes of direct sunlight 3 times a week?
- Are you often exposed to cigarette smoke?
- Do you feel that stress may be affecting your health?
- Do you often often feel tired?
- How would you describe your overall emotional well-being and mood? (poor, good, excellent)
- Are you a vegetarian?
- Each week, do you eat at least some cold-water fish?
- How many daily servings of dairy or calcium-fortified foods do you eat? (0, 1-2 , 3 or more)
Women are also asked:
- Have you entered or completed menopause?
- Any menopause or perimenopausal-related hot flashes, night sweats, or changes in mood?
- Pregnant or trying to become pregnant?
- Do you experience PMS?
Men are also asked:
- Do you urinate frequently or wake up to urinate during the night?
Something for Everyone
During the past two weeks, we took the test repeatedly and discovered that no matter how you answer the questions, you will be advised to buy at least one product. EVERYONE is advised to buy a multivitamin. Teenagers are advised to take Mega Vita Min Multivitamins for Teenagers, and everyone 19-49 and 50+ is advised to take a multivitamin that supposedly is formulated for their age and gender. All of these products include some ingredients that are unnecessary and others that exceed standard recommended amounts. Most people should not take multivitamins [2,3].
The algorithm for the other recommendations is easy to figure out.
- Selecting "tired" gets you a vitamin B12 supplement. This recommendation is senseless. Although fatigue could be a symptom of B12 deficiency, only a tiny percentage of people who are tired have this condition and people who have it do not need a product. They need a diagnosis, which no questionnaire can give them.
- Selecting "eye concerns" yields a product containing lutein and zeaxanthin. These substances, combined with zinc and omega-s fatty acids, have been shown to slow the progression of moderate to severe macular degeneration, but no supplements have been shown to prevent the disease, improve the outcomes of people with early disease, or benefit any other eye condition. However, they have not proven useful in preventing or treating any other eye condition.
- Concern about "joints" yields a "triple strength" product that contains glucosamine, chondroitin, and MSM. The product is described as "perfect for anyone looking for extra nutritional support for their cartilage and joints." However, these substances have not been proven useful for treating any joint problem.
- Air pollution gets you vitamin C, selenium, and vitamin E, none of which has been proven useful for countering the effects of air pollution.
- Cigarette smoke exposure gets you vitamin C with bioflavonoids and rose hips, none of which can protect against the ravages of tobacco use.
- Concern about the urinary tract gets you cranberry fruit concentrate with vitamins C and E. The evidence that cranberry juice or pills can reduce the frequency of recurrent urinary tract infections is questionable .
- Stress, tiredness, and poor emotional well-being gets you vitamin B complex, vitamin C/bioflavonoids/rose hips, vitamin B12, fish oil, and vitamin D, none of which would be appropriate treatment for emotional stress, fatigue, or depression.
- Digestive concerns get a recommendation for a probiotic. Probiotics may have a useful role in a few situations, but any such problem should be addressed with a medical diagnosis. Giving the same recommendation for all types of digestive problems is irresponsible.
- Blood sugar concerns trigger a recommendation for cinnamon/chromium and magnesium, which have no practical use for blood sugar control.
- Little or no sun exposure gets a recommendation for vitamin D 2000 IU. Although vitamin D supplementation is advisable for some people, this amount is more than most people should take.
- For vegetarians, B12, fish oil, calcium, and vitamin D are recommended. B12 supplements are important for vegetarians who eat no animal products, but the use of any other supplements should be based on a detailed analysis of the person's diet.
- Concerns about heart health yields recommendations for fish oil, coenzyme Q10, and magnesium. A fish oil supplement may be useful for people who eat little or no fish, but the others have no proven value.
- Concerns about blood pressure yields recommendations for coenzyme Q10 and fish oil, neither of which is useful for blood pressure control.
- Concerns about bone density triggers a recommendation for calcium, magnesium, and a vitamin D pill with 2000 IU. Any such recommendations should be part of a medically supervised program.
- Women trying to get pregnant are advised to take Puritan Pride's Pre-Natal Complex, which contains folic acid and 28 other ingredients. A folic acid supplement should be taken before and during pregnancy, but there is no good evidence that well-nourished women will benefit from the other ingredients in this product .
- The recommendations for PMS include a B-complex product, magnesium, and vitamin D. The evidence for using these is questionable.
- For menopausal symptoms, take a B-complex product, magnesium, and Estrobalance, which includes vitamin E, folic acid, calcium, and phytonutrients found in soy and black cohosh. The evidence for using these is questionable.
- Men who wake up to urinate during the night are advised to take a saw palmetto product. However, well-designed studies have found that saw palmetto does not improve urinary flow or prostate size in men with benign prostatic enlargement .
In short, nearly all of the recommended products are a complete waste of money. In a few instances, one or two ingredients might be useful but the product provides too much of them or contains other substances that are not.
Some ingredients are found in more than one product. For this reason, when several products are recommended, the total amount of these ingredients may be way too high. When Dr. Hall answered all questions honestly, she was advised to take six products. The recommendations were not based on any credible scientific evidence. But even worse, their combination would provide a daily total of 8000 IU vitamin D and 2044 mg of calcium in addition to the amount from food. The tolerable upper intake levels of these nutrients are 4000 IU of vitamin D and 2000 mg of calcium. For women over 60, the recommended dietary allowance (from food plus supplements) is 800 IU of vitamin D and 1200 mg of calcium. The usefulness of calcium and vitamin D supplementation remains uncertain, and calcium supplementation has been associated with increased cardiovascular risks. When Dr. Barrett answered the questions honestly, he was also advised to take six product, none of which he needed. His products included a total of 4000 IU of vitamin D. They also included 2000 mg of fish oil (an excessive amount) even though he indicated that he eats cold-water fish at least once a week.
Both Puritan's Pride and Healthnotes provide disclaimers. The footer of every page on the Puritan's Pride Web has three of them:
Puritan's Pride provides these articles for information only. They are not approved or recommended by us, do not provide medical advice, diagnosis, or treatment, and are not meant to replace professional medical advice or apply to any product.
These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure or prevent any disease.
The information provided on this site is intended for your general knowledge only and is not a substitute for professional medical advice or treatment for specific medical conditions. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition. The information on this website is not intended to diagnose, treat, cure or prevent any disease. Never disregard medical advice or delay in seeking it because of something you have read on the Puritan's Pride site. . . .
The information presented in the Vitamin Advisor is for informational purposes only and should not be considered medical advice. Nutritional recommendations are based on established guidelines for people of average health and on associations between vitamins, minerals, and herbs with health conditions from published scientific studies (human, animal, or in vitro), clinical experience, or traditional usage. These associations may not be true for all individuals and are not based on specific product brands or formulations. Nutritional and herbal products may vary widely in ingredient purity, concentration, and combinations, which may affect people differently. Consult your doctor, pharmacist, or other professional for any health problem and before adding supplements to your self-care practices or discontinuing any prescribed medications. It is important not to make any changes in your self-care, including taking supplements, before or after a surgery without your doctor's express recommendation. . . . The Vitamin Guide recommendations are in no way intended as a substitute for medical counseling and neither the publisher nor the authors have liability or responsibility to any person or entity receiving or using this information.
A more truthful disclaimer would read like this:
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.
The Bottom Line
For all of the above reasons and more, we do not believe that Puritan Pride's questionnaire provides trustworthy advice. Its questions and answers related to dietary adequacy are simplistic. Its disease-related questions lead to products that are useless, poorly formulated, or both. In proper professional hands, a well-designed questionnaire that includes a detailed dietary history can identify areas of overall diet that could use improvement. However, no questionnaire can be customized to make appropriate supplement recommendations, either for dietary improvement or for treatment. If someone's diet is inadequate, the best way to fix it is to eat more sensibly. If a diet is missing any nutrients, it may also lack components (such as fiber) that will not be supplied by pills. If you think your diet may be deficient, analyze it with the tools provided on the U.S. Department of Agriculture's Choose MyPlate Web site or seek professional advice from a registered dietitian (R.D.) or physician.
- How Vitamin Advisor works. Healthnotes Web site, accessed Feb 3, 2016.
- Hall HA. Should I take a multivitamin? Science-Based Medicine Blog, July 15, 2008.
- Barrett S. Dietary supplements: Appropriate use. Quackwatch, Nov 12, 2010.
- Crislip M. Cranberry juice. Science-Based Medicine Blog, Jan 14, 2011.
- Hall H. Prenatal multivitamins and iron: Not evidence-based. Science-Based Medicine Blog, Feb 2, 2016.
- Taklind J and others. Serenoa repens for benign prostatic hyperplasia. Cochrane Database for Systematic Reviews, Dec 12, 2012.
This article was revised on February 9, 2016.