Vitamin-C pills don't fall into either category. Instead, they're part of the incredibly popular, poorly regulated world of dietary supplements
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Health by the Carton
The boxes arrived just before my first blood test. The cardboard was crisp; the tape, perfectly cornered. But it was like a disappointing Christmas. Each box contained pills and powders and fake-food bars. There were so many that I had to start stacking them under the bed.
A few weeks earlier, I had completed an online evaluation for Usana Health Sciences, a Salt Lake City — based supplement maker with a reputation for high-quality products. According to Standard & Poor's, the company earned $565 million in revenue over the previous 12 months, which actually makes it one of the smaller players in the nutraceutical world. By comparison, GNC, a brand you may recognize from the mall, reports revenue of $1.93 billion. The world's largest pharmaceutical company, Pfizer, which earns most of its $68 billion in annual revenue from drugs, sold an estimated $463 million in supplements (like its Centrum vitamin) last year in the U.S., according to the Nutrition Business Journal.
The nutraceutical market is growing so fast among aging boomers that even giant food and drug companies are stumbling as they attempt to maintain their positions. Last year the Dannon Co., which makes Activia yogurt, settled allegations brought by 39 state attorneys general who objected to Activia ads suggesting the yogurt could prevent irregularity. A few weeks earlier, the drug company Bayer agreed to pay $3.3 million to three states after their attorneys general accused the company of claiming, wrongly, that one of its newer One a Day vitamin products reduces the risk of prostate cancer.
On the health form I completed for Usana, I reported my dietary habits (a combination of farmers'-market rectitude and late-night Rice Krispies Treats vice), sun exposure (less than 10 minutes a day), exercise routine (vigorous to the point of obsessive) and alcohol intake (enthusiastic). After I submitted the form, software at Usana crunched the data and kicked out a list of supplements I would need: eight pills in the morning and another eight at night, along with six other pills throughout the day. My a.m. HealthPak consisted of two Procosa IIs, two Mega Antioxidants, two Chelated Minerals, one CoQuinone 100 and one Proflavinol C 200.
One of the first things you learn about nutraceuticals is that the names are mostly made up. Procosa II is what Usana chose for a tablet that contains vitamin C bound with manganese and the chemical glucosamine sulfate, a naturally occurring compound found in the fluid around the joints that you can take as a supplement for arthritis. Usana's Mega Antioxidant pill contains vitamins A, B6, B12, C, D3, E and K, along with 19 other ingredients.
What exactly are all these substances? I discovered that no government agency catalogs (let alone tests) dietary supplements. Under a 1994 law, the federal government defines dietary supplements as any vitamin, mineral or herb (along with a few other more obscure substances) that is intended to be swallowed in order to augment diet. The U.S. Food and Drug Administration lacks the authority to approve prospective supplements for safety or effectiveness, and the agency can't act to restrict even a reputedly risky product until it hits the market. Since 1994 the FDA has banned only one dietary supplement — the dangerous weight-loss alkaloid ephedrine — and some industry critics say the agency needs more power. But safety isn't the real problem with nutraceuticals, most of which are harmless. Instead, effectiveness is the issue: many supplements may not do enough to be worth the money.
The Makings of a Guru
The decision about whether to take nutraceuticals is complicated by the fact that the lines among the three categories — food, drug and supplement — have always been scientifically blurry and politically contested. Ninety-nine years ago, a Polish-born chemist named Casimir Funk coined the term vitamine in a paper about his work with a substance in the inner bran layer of rice that Funk labeled in an experiment as "B1." And so B1 became the first named vitamin. Without B1, later dubbed thiamine, humans develop a disease called beriberi, for which B1 pills can be a treatment. But is B1 a food (a part of rice), a drug (a cure for beriberi) or a supplement (an additive you take just in case)?
In the years after Funk's discovery, an industry was born. Even before World War II, doctors began recommending cod-liver oil because it could provide the newly discovered vitamins A and D. During the war, the military sent millions of dollars' worth of vitamin tablets to service members around the globe, and food companies bought vitamin powders to use as enrichments for not only bread but even beer and jelly. These "fortified" products were, in some ways, the first nutraceuticals.