Whenever I offer a cup of coffee to a friend of mine, he always replies, "I don't do drugs."
He's right that coffee is a drug, but even he does drugs. Everybody does some drugs.
Maybe like him, you don't take a mild "recreational drug" like coffee and tea (which will give you a little dose of caffeine) or one of the more intense recreational drugs that can have serious side effects (like giving you a prison term). But drugs are everywhere in our modern society.
If we don't take drugs recreationally, we take them when our doctors recommend them. When our physicians prescribe them, we call them pharmaceuticals.
Over-the-counter medicines are also drugs. The big difference between prescriptions and OTC products is that your health insurance won't cover the cost of the latter.
When we take supplements, we are also taking something that we have to pay out of pocket. And supplements are actually every bit as much a drug as coffee or a pill from the pharmacy.
People with diabetes write me all the time to ask about different supplements that they take or are considering in lieu of diabetes medicine like insulin, a sulfonylurea, or metformin. These people have some concern about prescriptions - with some justification. Any drug can be dangerous. Any drug has a both a therapeutic and a toxic dose. Sometimes these levels can be awfully close together, and the toxic dose can have side effects as serious as those of recreational drug use.
So these well-intentioned people turn to supplements - but it is often a turn in the wrong direction. Some supplements, particularly multivitamin and mineral pills, are probably good for us. But few are well tested. Still, more than half of all Americans regularly take supplements, which include vitamins, minerals, amino acids, enzymes, and herbs and other botanicals.
Excluding coffee or tea drinkers, that means more of us probably take supplements than we do recreational drugs. And in one sense supplements are more like recreational drugs than prescriptions or OTC medicine. That's because at least in the United States the government doesn't regulate them.
Supplements have a huge legal loophole. Its name is the Dietary Supplement Health and Education Act of 1994. In a nutshell the law says that the government can't approve supplements either for safety or for effectiveness.
The Food and Drug Administration has the authority to ban really dangerous supplements, but only after the fact. A case in point is ephedra, which the FDA took off the market three years ago. But that was too late for a lot of people.
Safety is one thing. Effectiveness is another. And here the government can't ever help us when it comes to figuring out whether a supplement does anything for us or not.
The supplement industry, like the pharmaceutical companies, is big business. We spent $22 billion for supplements last year, according to a May 11 article in The Wall Street Journal, quoting the Nutrition Business Journal.
Of this amount we gave $4.4 billion to multilevel marketers, which now usually call themselves "network marketing associate programs." That's the new term of art, because the old term "multilevel marketing" leaves a bad taste in the mouths of many of us.
"Makers of nutritional supplements don't have to prove their products are safe and effective, and the products aren't evaluated by the FDA," wrote The Wall Street Journal. "But the trade-off is that makers of the stuff aren't allowed to market it for treating or curing disease."
The WSJ article took a close, unflattering look at one of the largest multilevel marketing company, Mannatech. This company's associates target people with just about any condition, including diabetes.
The company claims that its flagship product, Ambrotose, provides the nutrients "that your cells need to 'talk' to one another and to support your immune system." But some researchers doubt that we can get any benefits from Ambrotose, because we lack the enzymes that we would need to digest the plant fibers it contains.
It is, as the WSJ says, "a gray zone." Mannatech includes the standard FDA disclaimer that Ambrotose "is not intended to diagnose, treat, cure or prevent any disease." But the company's fervent sales associates aren't always so careful. If, for example, you put the words "Mannatech" and "diabetes" together into a Google search, you will get more than 34,000 results. Ambrotose and diabetes together will get you 23,000 results, but that may be all that it gets you.
Aside from supplements, prescriptions, OTC medication, and recreational drugs, we use still another category of drugs. The food companies are selling us more and more functional foods, claiming that these modified foods will improve our health, our quality of life, or our wellbeing.
Margarines fortified with stanols (such as Benecol) and phytosterols (such as Take Control) are perhaps the leading functional foods. But just between January and April 2005 companies launched 200 new functional food products, according to an article scheduled to appear in this Saturday's British Medical Journal.
That article cautions that we need to take a "closer evaluation" of these functional foods. The biggest concerns are with long term use and whether they interfere with other drugs.
I don't use any functional foods now, although I have in the past. But unlike my friend who isn't even a teetotaller, I am no drug purist. I take prescriptions for diabetes (Byetta) and for BPH (doxazosin and Avodart).
For recreation I continue to drink a few daily cups of coffee and an occasional cup of tea, but nothing more intense anymore. I also take some OTC drugs and supplements, but only after having carefully evaluated the evidence.
The evidence for almost all OTC drugs and supplements is scarce. In "Alternative Therapies for Diabetes"
I reviewed the best source of information about supplements, the "Natural Health Encyclopedia."
This source is moderate - in other words lukewarm - about almost every supplement. Still, it's my health now. While I don't fool myself into thinking that supplements aren't drugs and I am as careful as I can be, I can't wait to have all the evidence for their effectiveness that we would have in the best of all possible worlds.
While I avoid all supplements that any studies show might be dangerous, I realize that I might be wasting money on some supplements that don't do anything for me. But when it's a trade-off between my money and my health, it's a financial gamble I have to risk.