Caveat Emptor

Late last year, I had the good fortune of taking on Dr. Michelle Bestic as a client here. After welcoming the addition of two beautiful twins into her family with her husband Dr. Dan Bestic, she decided it was time to get the focus back on her and getting her body into the condition it was in prior to pregnancy. As you’ll soon find out, Dr. Michelle is a wealth of information on all things regarding pharmacology. I am frequently asked my opinion on a variety of supplements, aids and pharmaceuticals. While I definitely have an opinion, I certainly don’t have the pedigree and background that someone like Dr. Michelle has. So, I was excited when she was willing and able to let me interview her with her thoughts on a lot of the topics that clients come to me about. Without further ado, I hope you enjoy our latest newsletter with Dr. Michelle Bestic!

Dr. Michelle, thanks so much for taking the time to do this. So that we can give the readers some more insight, could you briefly give a background on yourself?

MB: I graduated with my PharmD (Doctor of Pharmacy) in 2004, then did a two year post-doc fellowship in pediatric pharmacology and toxicology.  I have been working as a clinical pharmacologist and toxicologist since 2006.  I have published two book chapters, 10 peer reviewed articles and given numerous lectures to physicians, nurses, pharmacists and students about a wide range of toxicology and developmental pharmacology topics, including several on supplements. 

The fitness supplement industry is a multi-billion dollar monster. That tends to explain why there are so many companies looking for a piece of the pie. How do you generally regard a lot of what you see on the shelves at say, a nutritional supplement retailer? 

MB: Generally when considering supplements, the first thing I consider is "Do no harm." That is, I make sure that the supplement is not going to interact with any prescription or over the counter medication or potentially worsen any medical conditions.  The second thing I consider is the manufacturer of the company, does the company follow what we call "good manufacturing processes". Beware of the terms "standardized, verified or certified" as US law does not actually define these.  Look for a "seal of approval," however, this does not guarantee safety or efficacy it merely ensures the product was properly manufactured, contains ingredients listed on the label and doesn't contain harmful levels of contaminants. 

Finally, the last thing that I consider is that on average it takes prescription medications 17 years to make it to market from development, after tests on thousands of people. Yet, there are still medications that despite all of this testing still have to be removed from the market after hundreds of thousands of people take them and still cause awful side effects.  On average it takes a supplement less than 6 months with no FDA requirement of proving safety or efficacy. In fact, a company only has to demonstrate that it is "reasonably safe for human consumption" prior to hitting the market and typically do not need FDA approval prior to hitting the market. So yes, I tend to ignore a lot of the stuff in nutritional supplement stores, especially any "new" products out there because I know they haven't had any safety data collected.


Sadly, there are so many people looking for that "magic pill" that solves their weight loss puzzle or, by comparison, helps them get stronger, faster. Is there anything on the market that you would consider could do the job in either case? 

MB: There is nothing currently on the market that offers a "magic pill" for weight loss. Sorry!  I always tell people the same thing when they ask, the FDA and big pharmaceutical companies are not conspiring to keep you overweight or unhealthy.  If there was truly something out there every major pharmaceutical company would be producing it because they would make billions and there would be multiple agents out there just like there are 10 different types of cholesterol lowering agents

A lot of people are looking for the herbal or homeopathic remedy to cure what ails them. The belief is that if it's not a tried-and-true pharmaceutical that it "naturally" is better for them. How do you feel about that? 

MB: I sort of addressed the last question with the FDA testing and requirements.  However, I will add a couple of things.  First, anything and I mean absolutely anything can be a poison when taken in an incorrect amount.  Excessive water consumption has killed people. Also there is a misconception that "natural" equals "safe."  Opium and nicotine are also "natural" substances yet I don't think anyone would label them as "safe."  I had a patient once take too many fish oil tablets and ended up in the hospital with significant toxicity.  I am not saying that there aren't products out there that may help, just that if you are avoiding prescription medications because you think they aren't "safe" consider the fact that the supplement you are about to take has never had to prove safety data to anyone!

What do you consider the best resource for a layperson to determine whether or not they should be taking a supplement? 

MB: I would like to think that a health care professional would be the best source but sadly a lot of us don't really keep up to date on all of the supplement information and data.  I really like this website: http://nccam.nih.gov/  It is the national center for complimentary medicine and integrative health.  It has a pretty decent review of a lot of herbal products. I also like www.naturaldatabaseconsumer.com 

Because you see weight loss through a different lens than someone like myself, what would be a pharmacist's approach to safe and effective weight loss? 

MB: Most pharmacists don't take medications! Haha! Most would tell you however that the safest way to approach weight loss is through a healthy, balanced diet and physical activity.  Supplement use should be limited to just that, as a supplement to possibly fill in gaps in your diet.  Example, someone with low iron may need iron supplements.  If you don't eat a lot of fish, perhaps omega fatty acids.

What is interesting is that there are agents that will cause you to lose weight.  Taking too high of a dose of amphetamines or thyroid medication certainly works, but you can die in the process.  They are highly toxic to your heart in the doses needed to cause weight loss.

In your opinion, how much impact does the placebo effect have on supplementation?

MB: The placebo effect response varies widely in many studies depending on the condition being treated and how a placebo was introduced to a patient.  Interestingly, the more someone believes something (placebo or not) is going to work, the higher the rates of response.  There are certainly studies where the placebo effect was 0% and there are ones where the results were >50%.  In general, most references state and it is generally well accepted that the placebo effect is anywhere from 25-33% of individuals. 

If there were some general words of advice you could give to the public, but most importantly, to the health-conscious readers of this newsletter, what do you want them to know?

MB: General words of advice is that there is no substitute for a healthy diet and active lifestyle.  Nothing comes close to mimicking the health benefits produced by these two things.  To put this in perspective, the World Health Organization has estimated that if the major risk factors for chronic disease were eliminated which are lack of physical activity, poor nutrition, tobacco use and excessive alcohol consumption, at least 80% of all heart disease, stroke and type 2 diabetes and more than 40% of all cancers would be prevented.  If you wish to use a supplement in conjunction with a healthy lifestyle just consider the following - the supplement you are choosing may lack appropriate safety data, tell your healthcare provider to make sure there are no interactions with any disease states or medications, choose a reputable manufacturer and be conscious of the doses of the supplement you are taking, more is not always better.

I’d like to again take a moment to thank Dr. Michelle for all the great information. I also have to give credit to her for helping me with the title of this newsletter since I was having a writer’s block! I’ll speak for both of us in saying, I hope you were able to take some pearls of wisdom from our chat together!