Which supplements really work? An interactive guide to evidence

BoingBoing isn't the only place trying out new design ideas today. Information is Beautiful has given us an exclusive preview of a new interactive infographic, designed to make it easy for anybody to parse the data on dietary supplements.

Each bubble represents a specific use—or group of uses—for a dietary supplement. The bigger the bubble, the more popular the supplement is, as measured in Google hits. The higher on the chart, the more solid the evidence supporting that particular supplement for that particular use.

David from IiB reviewed nearly 1000 studies to put this baby together, using studies with large numbers of subjects or meta analysis of multiple studies whenever possible. You can read more about the methodology on the site. Great work!

Still image version also available.

Maggie Koerth-Baker is the science editor at BoingBoing.net. She writes a monthly column for The New York Times Magazine and is the author of Before the Lights Go Out, a book about electricity, infrastructure, and the future of energy. You can find Maggie on Twitter and Facebook.

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MORE: Science • supplements

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Anonymous

I wouldn’t put Vitamin D on the same level as omega 3 or green tea – it is far more important than any of these. Vitamin D deficiency is extraordinarily comon, and low levels have been shown to correlate with a wide variety of conditions, most notably bone loss. It is a major component of calcium regulation in the body. Most medical associations recommend screening for deficiency, and often supplementation regardless in children.

There is most certainly high quality data supporting the use of vitamin D in certain populations. For example this meta-analysis of randomised controlled trials, published in Lancet 2007:
http://www.ncbi.nlm.nih.gov/pubmed/17720017
Total number of patients: 64000

Now, you might rightly argue that there is a sparsity of randomised controlled data showing the clinical benefits of vitamin D deficiency in young adults. I doubt anybody would waste time on such an enterprise. The risks of taking vitamin D are small, the benefits biologically plausible, and the magnitude of benefit in young adults without frank deficiency likely to be small. Why do an RCT in 100 000 people for 20 years to show that it is probably good for you?

If you are going to bother taking any vitamin however, vitamin D is probably the one, as it’s the only one someone eating a normal diet is (very) likely to be deficient in.
Teller

Do I understand this correctly: the efficacy of the supplement is based on the number of Google hits? Odd, very odd.
- Jonathan Badger
  
  It’s confusing, but if you look at the spreadsheet (on the linked site) that the bubbles are based on, you’ll see that the efficacy is measured by the number of positive citations in PubMed (a database of the biomedical literature). The Google hits are used only to change the size of the bubbles, not to group them vertically.
  
  It still isn’t perfect, a positive citation in something like _Nature_ is different from one in an obscure journal that may or not publish crap, but it’s not entirely nonsensical.
  - Teller
    
    Noted and thank you.
Anonymous

Magnesium, worthless? horse balls is it, clearly haven’t researched this well enough.
godfathersoul

Snake Oil!

http://www.snakeoilkoolaid.com
Anonymous

My wife’s a doctor and generally scathing about the efficacy of vitamin supplements, instead following the ‘eat well’ line.

However, for what its worth recent peer reviewed literature on Vitamin D and the general lack of it in us Northerners has made her go out and get supplements for the kids.

Not yo avoid cancer of course, just to ensure decent bone growth and a few other developmental general health effects
- Anonymous
  
  Tell your wife she has a lot to learn. Orthomolecular medicine has been curing people for a long time. Take a look at Linus Pauling, for example. Scoff all she wants – I cured my incurable RA (diagnosed as such by board certified specialists at Stanford) with my own supplement protocol. Not one symptom left. I researched the literature (it was all in the stacks at Stanford Med Library) and found just what I needed. I went from cripple to active in six months and in one year had no pain at all. My hands went from claws to normal – and its all right there in the old journals and texts. Here’s what happened – in the 50′s the FDA required testing and approval of all supplements and drugs. Many of the pharmcos sold supplements and just ditched them because there was no purpose in testing them since they could not hold a patent. Suddenly, they were “worthless” Yea, right – only to the drug companies.
pinup57

I’m a bit puzzled by the use of the term “supplements”. Most of the substances/ingredients/plants/fruits are just what they are, or are naturally part of ordinary food. Eat fish, you get Omega3. Calcium a “supplement”? Drink milk, eat yoghurt!
- Anonymous
  
  How can the term ‘supplement’ possibly be confusing?
  
  A particular compound is extracted into pill form intended to supplement a poor diet.
  
  Where’s the confusion?
- Gloria
  
  It’s not easy for everyone to include certain kinds of food in their diets.
  
  Aside from cost, time, and local availability, there are dietary concerns, both physiological and personal/religious. Some may be lactose-intolerant — so no milk — or vegetarian/vegan — so no fish. So many people may need to acquire their supplements in other forms.
  
  Also, remember that the term “supplement” can simply refer to the fact that it is not a vital vitamin/mineral/oil/etc. and therefore are optionally added. They “supplement” an otherwise perfectly acceptable diet.
  - coaxial
    
    With the exception of a physical reaction, like allergies, it actually is easy for people change their diet to eat more foods. Lactose intolerance is treated with a pill. Personal or religious reasons, are chosen behavior. Stop be superstitious and you can eat anything you want today. They simply choose not to.
    - Gloria
      
      I’m pointing out that not everyone subscribes to the same system and it’s not necessarily a bad or harmful thing. People make choices that restrict or change their lives every day based on all kinds of ideas and beliefs.
      
      Hell, maybe some people just don’t like the taste of milk or fish. That’s a personal choice too.
      
      Taking supplements instead of eating certain foods is an easy, no-harm alternative in most cases. I’m not sure why you think having certain beliefs inherently warrants such a belligerent attitude.
    - cymk
      
      The problem being, if a vegan doesn’t eat meat or animal byproducts, then his/her body has not longer can process them as easily as before. So if that person ever decides to go back to meat or eating “normal” they have trouble digesting the food and may even get sick. This of course reinforces their belief that meat is bad/evil and only veggies are good.
SeattlePete

So, is Cod Liver Oil fish oil or an Omega-3?

My bottle of Cod Liver Oil clearly comes from a fish, and claims to be “Rich in Omega-3s”. This infographic separates those two into different blobs…
- Anonymous
  
  Cod Liver Oil is fish oil, which contains Omega 3. But you can also get Omega 3 from other sources than fish, such as plants. And fish oil has other ingredients in addition to Omega 3, like vitamins. So separating them makes sense.
- Anonymous
  
  Interestingly enough, fish oil and omega-3 are virtually the same thing. The primary source of all omega type unsaturated fatty acids is fish oil, and so omega-3 fatty acid supplements are simply purified fish oil. Fish oil itself also contains omega-6 fatty acids, for example, which are also similarly beneficial.
  
  If you’re concerned about sustainability as I am (disclosure: for some time I did research about bioreactor culturing of alternative sources of omega-3 and omega-6 fatty acids, such as spirulina) then you might actually think twice before popping fish oil all the time though – if it isn’t already obvious to you, fish oil is questionably sustainable at best.
peterbruells

Sorry, but.. it looks beautiful, but I think it’s a horrible design. It’s PowerPoint to the max.

Same with the rising sea levels.

The “who gave what” is marginally better.

Yes, it’s moderately complex data, but not complex enough that one should need an explanation.
MagicGeoff

Fish oil and Omega 3 have never been shown to demonstrate anything relating to behaviour, intelligence or anything really so I don’t know why that bollox is in there.

The lobbying industry for Omega 3 in the UK have been demonstrated to use underhand tricks and guilt marketing on parents of small children (read Bad Science), so they can fuck off really.
- Anonymous
  
  I don’t see where this chart makes any claims with regard to fish oil/Omega 3 and behavior or intelligence. However, Plenty of such studies have found evidence in the realm that you describe as “anything, really”. Maybe do a little research before spouting off next time, and don’t stray too far off topic. You’ll sound much less bollux-y that way.
- SamSam
  
  Omega-3 has indeed been shown to have a host of benefits, which is why “that bollox is in there.” Most of the benefits, however, have to do with cholesterol, which is exactly what the chart says. The chart doesn’t mention “intelligence,” so I’m not sure what strawman you’re knocking down.
  
  The evidence for it’s effects on ADHD seem slim, according to the Wikipedia article, so I’m surprised they put that bubble at the “Good” level and not the “Promising” level. However, the article does note “Fish oils appear to reduce ADHD-related symptoms in some children.[68] Double blind studies have showed “medium to strong treatment effects of omega 3 fatty acids on symptoms of ADHD” after administering amounts around 1 gram for three to six months.[56][70][71],” so there is clearly some evidence.
  - Beelzebuddy
    
    No, it was shown to have some benefits for some dosages under some conditions. That’s the big caveat for dietary research – there are no magic bullets. Just because a result is significant doesn’t mean it’s worthwhile, or even noticeable on an individual level. In this particular case, there’s also evidence that plant-derived omega3s are ineffective. Which means most omega3 supplements out there are at best placebos. You just can’t boil it down to “this is good for you, that is not” in any generalized sense, no matter how you try.
chgoliz

I had difficulty leaving a comment over there (probably to do with the computer I’m using today), so I hope the creator reads this blog.

IODINE. Not on there anywhere. If you cook from scratch instead of using processed foods and don’t salt a lot, or only use pure sea salt, you might not be getting enough even in the US. That nutrient would be the highest bubble on the chart, if it were there.
- Anonymous
  
  iodide is in salt, not iodine.
k1p

Great. I just started taking a chrondroitin/glucosamine pill for joint pain a few days ago. Having read this, I now expect any placebo effect to be nil.
Enoch_Root

I can’t speak for all of them but at least with Vitamin D it should be taken with a big grain of salt (I am in biomedical research related to vitamin D like compounds and cancer). There is very good evidence that high levels of vitamin D correlate with low risk of certain types of cancer. However there is also good evidence that supplementing your diet with vitamin D does nothing to prevent cancer. And there is really definitive evidence that it is not good for treating cancer once it has formed.

This is a big problem with supplements vis a vis cancer and something that a lot of people simply don’t understand. Just because there is a correlation with high levels of chemical X in people who don’t develop cancer it doesn’t mean that taking it in pill form or eating some food high in X will do anything at all for your cancer risk. The other thing to take in to account is that with supplements there is very little information on long term effects of high doses of them. The studies are generally hard to do, very expensive, and confounded by a lot of variables. So doubling your vitamin D intake may not be harmful at all. Maybe it raises your risk of some cancers by some slight percentage. No one really knows. So are supplements good? Maybe. Bad? Unknown.
- Anonymous
  
  A great many random controlled trials have been made which have proven that taking vitamin D prevents about 8 cancers and helps treat 5 cancers. It is normally difficult to find this data when it is hiding in the thousands of other medical articles which just show association/correlation. http://www.vitamindwiki.com has many medical files which have the proof.
- Anonymous
  
  Not all the studies are simple examinations of the biochemical makeup of people who don’t exhibit some disease… some studies are actually of people who take a supplement vs people who don’t (the control group).
  
  There’s as much conflicting, generalistic opinion being posted as there are flawed studies
Snig

The original snake oil was rich in an omega 3, and was used for a few complaints, which likely had great efficacy and minimal side effects. Fake snake oil, or different species w/o the omega 3 component, were often sold, and oversold as a cure all.

http://en.wikipedia.org/wiki/Snake_oil

Disparaging things as snake oil shows the two errors commonly made with supplements:

Overselling shoddy products for too many uses

and

assuming that because it was not established or well researched medicine than it’s not legit.
- Jonathan Badger
  
  “assuming that because it was not established or well researched medicine than it’s not legit”
  
  You can’t think something is legit if it hasn’t been established and well researched. Why is this hard to understand? Yes, many “natural” products have been shown to be effective in good scientific studies. But until they’ve been *shown* to be effective in controlled trials it is simply mysticism to use them; many other natural products have been shown to be harmful. The wonderful thing about science is it is about changing opinions when new data is available and not being tied to “tradition”.
Patrick Austin

Link me to studies in pubmed or GTFO.
Rindan

Take this graph with a tiny grain of salt.

Every time I visit home my dearest mother nags me about how I should be taking vitamins, vitamin D in particular. I always make the same challenge. Show me three studies that show that taking a vitamin SUPPLEMENT (i.e. not just showing that high levels of something is associated with something else) in a double blind randomized did something. She never has been able to find anything.

So, I was pumped to pull open the raw data that made this graph and see myself proved wrong. I went over to vitamin D, the highest bubbles. What is the “strong evidence”? One literature review (junk), one study on measuring vitamin D levels vs health factors (suggestive on the benefits of D, but junk in terms of supplements), and one double blind on post menopausal women. The double blind on post menopausal women is vaguely promising, but one study on post menopausal women hardly counts as “strong evidence” that you should be wasting money on this junk.

Now vitamin D is at the top of the list and its support is one junk article, one article not on supplements, and one a narrow group of people. That gives you a pretty good idea as to how worthwhile the rest of those supplements are.

My advice? Save your money for some sugar pills and vegetables. You get to take continue taking a magic pill that will fix all your ills while actually doing something healthy for your body.
bolivar13

Not on topic per se – but does anyone know where red yeast rice got its name (it’s at the top of the diagram for those interested)?
I know it’s yeast grown on rice but why the yodafied name? I could see red rice yeast but wtf?
- dculberson
  
  It’s actually rice, not yeast. It’s rice that’s been inoculated with yeast, that turns it red and adds magic.
  
  http://en.wikipedia.org/wiki/Red_yeast_rice
regeya

Word of warning to everyone: Red yeast rice can contain lovastatin. And if it doesn’t, isn’t it kind of pointless to take it for blood pressure or cholesterol?

The prescription statins I’ve tried have terrible effects on me, so this sounded great to me, too, but I’m hesitant to try it since it’s just another statin.
thequickbrownfox

Fish oil is good for you?

Didn’t do the fish any good.
- Anonymous
  
  Keeps their scales from clinking, you know.
Jerril

Vitamin D as a supplement has been known for over 50 years as a preventative and treatment for rickets. It’s one of the better studied out there. For some of the other things that have made the news lately, there’s obviously less evidence (Seasonal Affective Disorder, memory problems, cancer prevention, immune function, etc) but arguing that the Vitamin D that has been added to milk for decades isn’t what eliminated rickets in the developed world is beyond “conservative” and into the “vaccines eat your brain” level of hysterical denial.

A small selection of Pubmed links:
http://www.ncbi.nlm.nih.gov/pubmed/18088161
http://www.ncbi.nlm.nih.gov/pubmed/15585788
http://www.ncbi.nlm.nih.gov/pubmed/17990825
http://www.ncbi.nlm.nih.gov/pubmed/14985208
http://www.ncbi.nlm.nih.gov/pubmed/9625080
http://www.ncbi.nlm.nih.gov/pubmed/5755261
http://www.ncbi.nlm.nih.gov/pubmed/19093162
http://www.ncbi.nlm.nih.gov/pubmed/15989379
- Rindan
  
  Jerril, your links are all junk. Not a single one of them is a double blind study on humans. In order of your links Jerril,
  
  Lit review
  Correlation
  Correlation
  Lit review
  Correlation
  Animal Test
  Lit review
  
  In other words, not a single double blind on humans. YES everyone agrees that vitamin D is probably good for you. If you don’t have some in your body, you are dead. The question is whether or not taking it in the form of a highly concentrated pill does anything.
  
  This is the big flaw with most the studies cited in defense of “supplements”. They focus on correlation studies that show that people with high levels of X are healthier in some way. They don’t ask the real question, which is, “if I take a lump of X in a highly concentrated pill form and ram it through my digestive-tract, does anything good happen?”
  
  The answer when it comes to vitamins is almost universally no. There are a few exceptions, but they are the exception and not the rule. Throwing a lump of highly concentrated crap in a pill just results in really nutritious shit and various chemically degraded lumps of whatever you just tossed in. At worst, you might be doing yourself long term damage because your body actually IS absorbing high levels of whatever.
  
  If you want to be healthy, eat some veggies and exercise. If you feel you need more, take a sugar pill. Save your money for real food. If someone badgers you to take some placebos, ask them to show you a couple of double blind studies showing that their placebo of choice actually does anything. That will shut them up for a while.
  - ecologist
    
    There is a common myth that the *only* kind of study that provides evidence is the double blind, randomized, prospective experiment. That, unfortunately for commentors like Rindan, is not true.
    
    Particularly untrue is the inference that the lack of such studies provides evidence. It does not. An experimental study that tries and fails to find an effect provides some (negative) evidence. But to go through a list of other kinds of studies and blow them off with “not a single double blind on humans” is a bit off the mark.
    
    That said, however, any study (including the oh-so-wonderful double blind experment) deserves scrutiny for its design, execution, and analysis.
Anonymous

These vitamin D haters are mis-informed. There is scientific evidence that points to benefits from supplementing with vitamin D. Prospective studies exist that show that people with high vitamin D levels, even those who supplement, have lower incidences of events.
One prospective study found that insufficient vitamin D levels increased chances from death FROM EVERYTHING by a factor of two.
Get a little sun (in the summer) and get a little supplementation. Nothing overdone is good for you. Vitamin D will not cure all your problems on its own, but it looks (scientifically) to be a very good co-factor for exercise and proper nutrition. Nothing will ever exist that will undo all of the horrible things one can do to one’s body. There’s no reset button.
But don’t take my word for it. Do some research yourself.
Jerril

I’ve got a comment being held for approval for a huge pile of pubmed links on Vitamin D (not surprised, looks like linkspam). Should show up in an hour or something, I guess.
Anonymous

This Graph is grossly oversimplified. Take Omega-3. Yes, it works, but only if you take Omega-6 with it.

Probiotics is fine, but you have to keep using it to generate beneficial effects. Probiotics is essentially a bacteria culture added to your own bacterial culture. To survive, it will have to compete with your own bacteria, which fight it’ll lose unless you keep adding more every day. Better is to take prebiotics, which supports your already existing bacteria culture and is ALOT cheaper (it’s in onions, bananas, artichokes, etc.)

Sorry, I’ve just spend the better the past few months researching the truth behind additives and supplements and the only conclusion I could draw was that there is no such thing as a super-cure (or super-supplement) The only supplement IIRC on that list that without a doubt is good for you, is folic acid, but only when you’re pregnant.
Anonymous

This infographic is a thing of beauty. Seeing it has already made my life better. I’m being sincere.

All you doubty-pants seem to be overlooking the fact that the author started with skepticism, analyzed a ton of studies and came up with this. This is enough for me. If I end up wasting a little money on licorice root, well I guess that’s just the cost of picking my battles. This one page offers a bah-zillion times more information than I had on hand any other time I’ve picked out vitamins.
RedShirt77

Eh, lovely chart. As with all suppliments it has terrible research.

Put “promising” at the top of this chart and “as good as Homeopathy” at the bottum of this chart and you will have a healthier outlook.

It’s almost always better to get nutrician from food. Folks shouldn’t be spending hundreds on placebo pills.
Anonymous

I have to agree with the previous commentor; the scale should be promising at the top and as good as homeopathy at the bottom.

The chart is pretty, and I was just about to pass it along to people when I figured I’d look to see what the best usage for valerian root was. Evidence for valerian=strong for sleep and anxiety according to the chart.

The study sited in the google docs was indeed a double blind human study and it concluded valerian root has no statistically significant effect on sleep but is not harmful.
Anonymous

Can’t you all find enough reasons/forums to disparage the graphic, denigrate studies and refute all supplements as useless? This is a generalist graphical representation that is easier on the eyes than looking at lists of research studies and textual frequency charts. I think it probably does separate some of the promising from some of the nonsense and that’s enough by itself. Nobody is pushing a government nutrition chart release here or stating statistics.
tedweinstein

I have to question this chart/methodology because of how high it places St. Johns Wort. A number of recent studies have concluded that St. John’s wort is ineffective in treating depression. I’d like this chart more if it weren’t one person’s views of effectiveness but rather was his visual representation of some more expert, group assessment of these various supplements.
Anonymous

Mirror?