By Laird Harrison

Which supplements actually work? Bombarded by reports of new research along with marketing hype, even the best healthcare professionals struggle with that question.

Consider the offer I got through Twitter last month: a new supplement that could dramatically enhance my strength and energy. How could an aging athlete resist?

The supplement maker, Meehan Formulations, backed up its claims with a clinical trial. After 10 weeks, the 31 people who took its supplement, ATP, felt more energetic. And they trimmed their waists by an average of more than two inches with no ill effects. Meanwhile people who took fake versions of the pills got fatter.

“Not only is it safe but it’s outperforming many prescription drugs on the market from what I’m seeing,” the company’s founder, Kevin Meehan told me over the phone.

Meehan, an acupuncturist in Jackson, Wyoming, explained that formula supplies key ingredients cells need to get energy from food. (ATP stands for adenosine triphosphate.) It all sounded great.

But I’m not taking the pills. Ultimately the evidence they are helpful and not harmful falls far short of mainstream scientific standards. And the way Meehan is marketing them illustrates the enormous challenge we all face in figuring out which supplements actually work.

Fighting Diabetes

Meehan first got interested in medicine when he was diagnosed with diabetes at age 13. His health later improved, but the interest stayed with him through college. He got a master’s degree in oriental medicine from Oregon College of Oriental Medicine and began practicing acupuncture in Jackson, Wyoming.

Why Oriental instead of Western? “I feel it brings a more dimensional result rather than a linear one to not only my protocols used on patients but my scientific work as well,” he said in an email.

These studies included biochemistry, and Meehan has put this knowledge to work creating supplements he believes can work against diabetes and other common ailments.

But under the laws governing food and drugs in the United States Meehan can’t say anything about diabetes in his marketing materials. If he does, the U.S. Food and Drug Administration will consider ATP a drug, and he will need to prove the claims.

He’ll have to complete at least three clinical trials in which hundreds or thousands of patients take the drug while a similar number of patients take a fake drug so the outcomes can be compared for safety and efficacy.

This is not an arbitrary bureaucratic hurdle. It’s the only way we can know a drug is helpful, and it’s also the best way of knowing which supplements actually work. The clinical trial Meehan has done so far is a good start, but it’s too small to be definitive. The smaller the trial, the greater the  risk that the outcomes can be due to chance.

And this trial hasn’t yet been reviewed by a set of independent experts in the field, as it would if it were published in a good academic journal.

No Proof Required

Trials like the ones required by the FDA cost millions of dollars. And if your product is made up of ordinary ingredients that can’t be patented — such as herbs or vitamins — competitors might easily duplicate your product.

For that reason, most supplement makers prefer not to put them through clinical trials. Instead they craft their marketing statements to imply their products have benefits without mentioning specific health problems.

“ATP is a revolutionary, all natural, patented formula that works at the cellular level to maximize the chemical potential of ATP production, the molecular source of energy,” reads the label of Meehan’s ATP. “The unique formulations in ATP is calculated to include the body’s own biochemistry to achieve optimal energy levels.” Elsewhere it bears the words “Energy. Stamina. Recovery.”

That’s where our current system of regulating supplements breaks down. Meehan’s small, unpublished study doesn’t prove that ATP will “achieve optimal energy levels” or have any effect on stamina or recovery or that the product is safe.

The ingredients are nothing new on a molecular level. They’re familiar vitamins and minerals: thiamine, riboflavin, niacin, calcium, magnesium, sodium and potassium. And there are some less familiar ones: CoQ10, alpha lipoic acid and aspartic acid. Finally, there is salt and cellulose.

Since these ingredients were all sold in foods before 1958, the FDA classifies them as GRAS: “generally recognized as safe.” That’s why Meehan can legally sell his supplements without having to prove they are safe or effective. These loose regulations are a big reason for all the confusion about which supplements actually work.

The Dose Makes the Poison

Just because the ingredients are called “vitamins” and have been in food since before 1958 doesn’t make them safe. There’s an old saying in medicine, “The dose makes the poison.” Even water can be toxic if you drink too much. And modern technology allows us to produce ingredients in much higher concentrations than they are found in whole foods. In 2012, U.S. poison control centers reported 68,168 cases of people sickened by vitamin overdoses.

Each dose of Meehan’s ATP formula includes 12 times the amount of thiamine the FDA says adults need per day, 21 times the amount of riboflavin and almost twice the amount of niacin. He recommends that people take one to three of these capsules three times a day.

I’m willing to accept that the 31 people who took ATP in Meehan’s trial didn’t experience any ill effects, but problems could arise for other people, especially if they continued to take the supplement for a longer period of time.

I don’t mean to pick on Meehan. Health food stores are overflowing with unproven products. Americans spend billions of dollars on them every year. Meehan’s clinical trial puts his product on a more scientific footing than most.

But so far the research shows that a lot of this money is being wasted. With few exceptions, vitamins and minerals only help people whose diet is deficient in those specific vitamins or minerals, or who have an illness that prevents them from properly assimilating these ingredients from food.

So the answer to the question, “which supplements actually work?” is different for everyone. Very large published studies have shown that multivitamins have no clear benefit in the average person eating a balanced diet.

Which Supplements Actually Work

It makes sense. Over millions of years, our bodies evolved to make optimum use of the ingredients available in food.

Meehan has an answer for that. “Unfortunately our environment is not what it was years ago,” he says. “We have things like carbon monoxide. We have farming techniques.”

And if he follows through on his plans to do more trials, he could one day end up with the kind of evidence that convinces the FDA, other mainstream scientists and skeptics like me. He could even cure diabetes, producing an unprecedented benefit for all of humanity.

He’s just not there yet.

So for now, I’ll pass on Meehan Formulations’ ATP. For the same reason, I’ve stopped taking most other supplements.

I do believe they have a role, but only when there’s overwhelming scientific evidence that the benefits outweigh the risks.

Six Steps to Choosing Supplements

Here are my simple guidelines for knowing which supplements actually work for you:

1) Eat a balance diet such as the Mediterranean, Japanese or Dietary Approaches to Stop Hypertension (DASH) diets. Then you can assume you’re getting all the vitamins and minerals you need.

2) If you can’t stay on one of those diets, keep a detailed food diary for a couple of weeks to see what vitamins and minerals are in the food you are eating. For packaged foods, you can use nutrition labels. For basic ingredients you can use this tool from the U.S. Department of Agriculture. Cross reference them with the FDA’s daily values.

3) If you can’t keep track of your diet, and you think you might be deficient in something important, ask your doctor for a blood test. For example, my doctor once told me, based on a blood test, that my levels of vitamin D were insufficient.

4) Try adjusting your diet. I’m eating more fish because fish are high in vitamin D. If you’re short on riboflavin, you could eat more cheese, almonds, fish, meat, mushrooms or spinach.

5) If you find these changes impossible to make, take supplements that provide exactly those vitamins or minerals you are missing in the doses recommended by the FDA.

6) If you hear about some important nutrient not on the FDA’s list, search the websites of large established organizations such as the American Dietetics Association, the American Heart Association, the American Cancer Society and the National Institutes of Health to see what they are saying about that nutrient.

A good example is omega-3 fatty acids. You won’t find it mentioned specifically on the FDA list of daily values, but these organizations all recommend you consume it. Since I have trouble eating enough fish, I sometimes take fish oil supplements. They’re just about the only supplements I consume.

They don’t give me an energy boost, or make me thinner, or cure diabetes. But a large number of really big studies published in important journals and endorsed by leading experts show they could reduce my risk of death. That’s the kind of evidence I need to take a pill.