Don't Trust Advice from Dietary Supplement Retailers!
Stephen Barrett, M.D.
Advice from retailers is a major factor in the sale of herbal and dietary supplement products. Laypersons (such as health-food-store clerks) who diagnose ailments or prescribe products from their stores are practicing medicine without a license—which is prohibited by state laws. "Prescribing" can also be construed as the unlawful practice of pharmacy.
Many investigation have shown that retailers routinely ignore these laws. Government enforcement efforts, which are limited, are directed primarily against manufacturers. Here are some of the reports I have collected.
In 1976, Eric Faucher, a National Enquirer reporter, visited 16 health-food stores in major American cities and complained of afternoon fever, weight loss, insomnia, and fatigue-symptoms that could indicate a serious disease such as cancer. Only one salesperson told him to see a doctor. The rest prescribed various supplements for such diagnoses as "high blood pressure," "imbalance of energy," and "hypoglycemia." "One salesgirl was stumped by my symptoms," Faucher reported, "so she called up her mother (the store owner) who prescribed vitamin E without ever seeing me!" 
In 1980, Sheldon S. Stoffer, M.D., and three associates from the Northland Thyroid Laboratory in Southfield, Michigan, described what happened when several of their employees consulted a supervisor or "nutritionist" at ten health-food stores. The investigators stated that their goiter was being treated with thyroid hormone and asked whether any of the store's products would help. All ten retailers said yes. Two advised stopping the hormone treatment, six advised taking kelp, two advised taking iodine tablets, two advised using a raw-gland preparation containing thyroid, parathyroid, pituitary and adrenal gland extracts, and one advised taking a raw thyroid preparation. (Health-food-store products made from animal glandular tissues are not legally permitted to contain potent amounts of hormones. Some do, however, but they are not reliable because the dosage is variable.) Other phony remedies included turnip tops, parsnips, parsley, malt tablets, and vitamin and mineral supplements .
In 1981, Julian DeVries, 76-year-old medical editor of the Arizona Star, visited a health-food store complaining of weight loss, loss of appetite, insomnia, leg cramps at night and psoriasis (a skin disorder). "Two young clerks sold me an assortment of vitamins for $124.34 that, according to a doctor, easily could have worsened the conditions I told them I had," DeVries reported. Instead of being referred to a physician for diagnosis of his possibly serious symptoms, he was sold megadoses of several vitamins; a product containing ginseng and an adrenal substance; digestive enzyme tablets; an iron-and-molasses compound; tryptophan tablets; skin cream containing vitamin E and PABA; and a book that suggested a nutritional cure for almost every ailment known to humans. The clerks said that their recommendations were authoritative because they had taken a three-week course in vitamin nutrition in which the book was used .
In 1983, researchers from the Columbus Monthly contacted nine health-food stores in central Ohio, by phone or in person, posing as women suffering from an undiagnosed eye condition, a mother-to-be seeking nutrition information for her pregnancy, a recent heart attack victim, and a would-be weightlifter seeking to build muscles. They concluded that although the store clerks appeared to be sincere, their advice was "like flipping a coin." 
In 1983, three investigators from the American Council on Science and Health made 105 inquiries by phone or in person at stores in New York, New Jersey, and Connecticut. Asked about eye symptoms characteristic of glaucoma, 12 retailers attempted to diagnose the problem (all incorrectly) and seventeen out of 24 suggested a wide variety of products for the investigator's "mother." None recognized that urgent medical care was needed. Asked over the telephone about sudden, unexplained 15-pound weight loss in one month's time, 9 out of 17 recommended products sold in their store; only seven suggested medical evaluation. Seven out of ten stores carried "starch blockers" (bogus diet pills) despite an FDA ban. Nine out of ten recommended bone meal and dolomite, products considered hazardous because of contamination with lead. Nine retailers made false claims of effectiveness for bee pollen, and ten did so for RNA. The investigators concluded that most health-food store clerks give advice that is irrational, unsafe, and illegal .
In 1986, Claire Aigner, R.D. posed five similar questions to ten health-food store proprietors in eastern Pennsylvania and concluded that only 46% of the answers were correct .
In 1989, volunteers of the Consumer Health Education Council telephoned 41 Houston-area health-food stores and asked to speak with the person who provided nutritional advice. The callers explained that they had a brother with AIDS who was seeking an effective alternative treatment for HIV. The callers also explained that the brother's wife was still having sex with her husband and was seeking products that would reduce her risk of being infected, or make it impossible. All 41 retailers offered products they said could benefit the brother's immune system, improve the woman's immunity, and protect her against harm from HIV. The recommended products included vitamins (41 stores), vitamin C (38 stores), "immune boosters" (38 stores), coenzyme Q10 (26 stores), germanium (26 stores), lecithin (19 stores), ornithine and/or arginine (9 stores), gamma-linolenic acid (7 stores), "raw glandulars" (7 stores), hydrogen peroxide (5 stores), homeopathic cell salts (5 stores), Bach flower remedies (4 stores), blue-green algae (4 stores), cysteine (3 stores), and herbal baths (2 stores). Thirty retailers said they carried products that would cure AIDS. Not one recommended abstinence or use of a condom .
In 1991, Julia M. Haidet, a student at Kent State University, made 30 phone calls to ten stores in Central Ohio for advice about headaches, kidney stones, or abnormal thirst, dizziness, and fatigue. She received no appropriate advice .
In 1993, armed with a hidden camera, "Inside Edition" visited four health-food stores in New York City to ask whether they carried anything for fatigue and headaches; blurred vision; arthritis; shortness of breath of a "grandmother who just had bypass surgery"; strengthening the immune system; improving memory; and/or "cleansing the blood." Products were recommended in response to every question. When asked for a product that could help people with AIDS, one GNC store manager recommended an amino acid product that he said was one of the store's top sellers. He also said the product was supposed to "help block the chemical inhibiting the growth of the virus" and did not have the toxic side effects of AZT. When confronted later, however, he denied recommending the product for AIDS.
In 1993, "CBS Evening News" showed: (a) a GNC clerk recommending a vitamin product to prevent hair loss, (b) a Nature Food Centres clerk endorsing a fish-oil product as an arthritis cure, and (c) another retailer recommending "E, C, A, shark-oil capsules, all of these things help" for cancer. The program reported that CBS News had sent fifty vitamin and mineral products to independent laboratories for analysis to see whether they contained the amounts claimed on their labels. Many were found to contain too little or too much. Michael Jacobson, Ph.D., executive director of the Center for Science in the Public Interest, commented that going into a health-food store "is like being the victim of one hundred different snake oil salesmen." 
In 1993, FDA agents visited local health-food stores throughout the United States, posing as prospective customers. The investigators asked, "What do you sell to help high blood pressure?" "Do you have anything to help fight infection or help my immune system?" and/or "Do you have anything that works on cancer?" Of 129 requests for information, 120 resulted in recommendations of specific dietary supplements .
In 1994, Jennifer E. Pumphrey, a student at Kent State University, inquired about ephedra-containing products at 10 randomly chosen health-food stores in the Cleveland metropolitan area. In each store she found an "energy booster" containing ephedra and asked: "Do you think this works?" and "Is it safe? Does it have any side effects?" At two stores she was correctly told that the products were powerful and should not be taken by people with high blood pressure. At the rest she was told that the product had no side effects. Some said it was harmless because it was herbal, natural, or "not a drug." Ephedra contains a stimulant that is potentially dangerous for people with high blood pressure .
Between 1985 and 1997, the late John Renner, M.D., a board member of the National Council Against Health Fraud, sought advice for health problems at more than a hundred health-food stores in 20 states and the District of Columbia. In all but two stores, he was advised to buy products. Renner also observed hundreds of customers shopping at these stores. More than half asked for advice about a health problem, and almost all questions led to inappropriate advice.
In 1998, a researcher posing as the daughter of a patient with metastatic breast cancer inquired at 40 health-food stores in Oahu, Hawaii. After products to assist in metastatic breast cancer care were mentioned and/or shown, if store personnel did not provide any further information, the researcher asked: (a) How does the product work? (b) Do you recommend any particular brand (if more than one brand available)? (c) Could I write down some prices? (d) How much of the product does my mother need to take per day? (e) Can the product(s) be taken together with the medication my mother is receiving from her physician? and (f) Is there anything else you can recommend? Personnel in 36 of the stores recommended one or more of 38 inappropriate products, the most common of which were shark cartilage (recommended by 17) and essiac (recommended by 8), and maitake mushrooms (recommended by 7). 
In 1999, a researcher asked employees at 12 stores in Mississippi, Tennessee, and Alabama what they recommended for depression. All 12 recommended St. John's wort products, and none asked about whether the cutomer was seeing a healthcare professional. Analysis of the products found that two contained almost none of the presumed active ingredient and that the recommended dosages of the others would deliver a wide range of intake .
In 2004, a researchers posing as a woman 8 weeks' pregnant masde 155 calls in the Phoneix area to ask retailers for recommendations for treatment of nausea/vomiting and migraines. They found that 89% of stores offered recommendations for nausea/vomiting and 82% provided recommendations for migraines. Ginger was the most recommended product for nausea/vomiting. Only 3.6% of respondents recommended correct usage, but failed to supply the correct dosage and duration. A total of 15 of 278 (5%) were for products contraindicated in pregnancy .
Similar findings have been reported by investigators in England , New Zealand , and Canada [17-20 In one of the Canadian studies, eight students told retailers at 34 stores that their mother was suffering with breast cancer. The average cost of recommended products was CN$58 per month. The recommendations included 33 different products, none of which was supported by evidence of effectiveness. Only 11 employees (32%) asked whether the patient was taking prescribed medication; three (9%) discussed the adverse effects of the products, and eight (24%) pointed out that the products might interact with prescribed drugs. Two employees suggested that the products might cure the cancer, and one advised stopping standard treatment with Tamoxifen because it was "poisonous."  In another of the Canadian studies, investigators found that 22 out of 34 stores recommended kava kava despite the fact that Health Canada had warned against its use .
Studies in Canada and New Zealand have found that health food retailers were far more likely than pharmacists to give inappropriate advice. In Canada, All of 20 health food retailers but only 4 out of 38 pharmacies recommended dietary supplements and/or herbs for the treatment of high blood pressure and 14 of the health food retailers said that their products were superior or equal to medicinal drugs . In another study, undergraduate students visited 192 health food stores and 56 pharmacies located across Canda. In about half of the stores they asked whether a specific supplement would help to prevent a particular condition or enhance health in a particular way. In the rest of the stores, they asked for advice on particular health concerns. They found that 88% of times that questions were asked in health food stores, the recommendations were either unscientific (6%) or poorly supported by the scientific literature (82%). This occurred for only 27% of visits to pharmacies. The percentage of visits that yielded advice considered accurate or fairly accurate was 68% for pharmacies and 7% health food stores . In New Zealand, 25 out of 26 health food retailers recommended products and did not refer the researchers to a medical practitioner; whereas 25 out of 26 pharmacists recommended an immediate visit to a medical practitioner .
In 2016, Consumer Reports published a list of 15 supplement and herbal ingredients that consumers should always avoid: aconite, caffeine powder, chaparral, coltsfopot, comfrey, germander, greater celandine, green tea extract powder, kava, lobelia, methylsynephrine, pennyroyal oil, red yeast rice, usnic acid, and yohimbe . The magazine also sent sent 43 secret shoppers to Costco, CVS, GNC, Walgreens, Whole Foods, and the Vitamin Shoppe—60 stores in 17 states—where they asked employees (mostly sales staff but also some pharmacists) about products containing several of the ingredients. Most of the employees didn't warn the shoppers about the risks or ask about pre-existing conditions or medications they might be taking, and many gave information that was either misleading or flat-out wrong .
The Bottom Line
Remember that the vast majority of people who work at health-food stores have no formal training in nutrition or health care and are not qualified to give advice about health matters. If you have a health problem, see a qualified physician. For advice about your diet, a registered dietitian is usually the best choice.
- Faucher, E. Beware of health food store salesmen. National Enquirer, May 23, 1976, p 9.
- Stoffer SS and others. Advice from some health food stores. JAMA 244:2045-2046, 1980.
- DeVries J. Health-store 'cures' win little respect from doctor. Arizona Republic March 8, 1981, pp A1-2.
- Motil B: Advice from the health food stores: How healthy is it? Columbus Monthly 10:79, 88, Jan 1984.
- Meister KM. Do health food stores give sound nutrition advice? ACSH News and Views, May/June 1983.
- Aigner C. Advice in health food stores. Nutrition Forum 5:1-4,1988.
- Martin N. AIDS fraud rampant in Houston. Nutrition Forum 7:16, 1990.
- Haidet JM. Poor advice plus doubletalk: A probe of "health food" stores in central Ohio. Nutrition Forum 9:6-7, 1992.
- CBS Evening News, May 24, 1993, 6:30-7:00 PM.
- Unsubstantiated Claims and Documented Health Hazards in the Dietary Supplement Marketplace. Rockville MD: Food and Drug Administration, June 1993.
- Pumphrey JE. Marketing of ephedra products in health food stores. Nutrition Forum 12:33-34, 1995.
- Gotay CC, Dumitriu D. Health food store recommendations for breast cancer patients. Archives of Family Medicine 9:692-698, 2000.
- Glisson JK and others. Clinic at the health food store? Employee recommendations and product analysis. Pharmacotherapy 23:64-72, 2003.
- Health food stores' recommendations for nausea and migraines during pregnancy. Annals of Pharmacotherapy 39:274-279, 2005.
- Vickers AJ and others. Advice given by health food shops: is it clinically safe? Journal Annals of Pharmacotherapy of the Royal College of Physicians 32:426-428, 1998.
- Healy B and others. Do natural health food stores require regulation? New Zealand Medical Journal 115:U165, 2002.
- Calder J and others. Health information provided by retail health food outlets. Canadian Journal of Gastroenterology 14:767-771, 2000.
- Mills E, Ernst E, and others. Health food store recommendations: Implications for breast cancer patients. Breast Cancer Research 5:170-174, 2003.
- Mills E and others. Emerging issues associated with HIV patients seeking advice from health food stores. Canadian Journal of Public Health 94:363-366, 2003.
- Mills E. and others. Impact of federal safety advisories on health food store advice. General Internal Medicine 19:269-272, 2004.
- Koren G and others. Comparison of verbal claims for natural health products made by health food stores staff versus pharmacists in Ontario, Canada. Canadian Clinical Journal of Pharmacology 13:2251-256, 2006.
- Advice on dietary supplements: a comparison of health food stores and pharmacies in Canada. Journal of the American College of Nutrition 28: 674, 2009.
- Sibers R and others. High blood pressure advice given by natural health food stores. New Zealand Medical Journal 122. 2009.
- 15 supplements ingredients to always avoid. Consumer Reports Web site July 27, 2016.
- Supplements can make you sick. Consumer Reports Web site, July 27, 2016.
This article was revised on November 1, 2016.