Watch your mouth—words, including ‘nutraceutical,’ matter

During a recent dietary supplement scientific webinar, hosted by a major national governmental health research organization, a guest presenter criticized the science supporting certain dietary supplement benefits.

The speaker, who was prescriptive with their words, used the term “nutraceutical” to define all supplement products and ingredients being discussed.

While the speaker was a scientist and not a regulatory expert, the speaker truly may not understand the full meaning behind “nutraceutical.” Considering this, it potentially biased the speaker’s overall opinion of dietary supplements. This is how rumors—and bad regulations—get started.

Words matter, especially when used in regulations that define a product’s category. And some words have different meanings depending on who uses them and how.

For example, the message might carry more weight if it’s delivered from a top industry or regulatory leader. While the speaker’s word choice provided insights into their understanding—or more likely misunderstanding—of the term nutraceutical, it carried the potential for misguided expectations when it comes to dietary supplements. So, what does this term really mean if anything?

“Nutraceutical” is a catchy marketing word, not a scientific term, first coined in 1989 by Dr. Stephen DeFelice, when he combined “nutrition” and “pharmaceutical” to describe “food, or parts of a food, that provide medical or health benefits, including the prevention and treatment of disease.” Since then, the term has been used loosely and has been redefined on several occasions but has no formally agreed-to definition or regulatory status.

Some industry stakeholders use it to describe dietary supplements, but it has also been used to describe fortified foods, medical foods and bioengineered foods. In theory, nutraceutical is a word that seeks to convey the therapeutic value of nutritional products. But in reality, the word is a portmanteau masquerading as a policy. It exists vaguely, exposes unresolved health and safety questions, and foments confusion and criticism in the dietary supplement marketplace.

From a legal or regulatory standpoint, Dr. DeFelice’s definition puts nutraceuticals into the category of drugs. This is a non-debate from the U.S. Food and Drug Administration’s (FDA) perspective because nutraceuticals are defined as having “medical benefits, including the prevention and treatment of disease.”

In the U.S., products are regulated based on their intended use and when a product is intended to prevent or treat disease, it is considered a drug. This is a subtle but important distinction that is often underappreciated, leading to category confusion and misguided expectations.

It seems innocent to use fanciful and loosely defined terms in marketing or consumer writing. However, terms like nutraceutical, herbal medicine, natural pharmacy and others contribute to preconceived expectations and criticisms of dietary supplements among scientists, health care providers and consumers.

In fact, we think the misperception that dietary supplements are in fact nutraceuticals leads to comments that dietary supplements “don’t work.” Consumers should also not expect supplements to act like prescription drugs. If you call something a duck, but it’s actually a goose, it leaves the door open for people seeking ducks to be disappointed.

When dietary supplements are (unfairly) expected to work like drugs, tested against those standards, and fail to match those expectations, researchers, health care providers, consumers and the media are hypercritical and skeptical of the entire dietary supplement category.

One example is the infamous 2013 Annals of Internal Medicine editorial with the memorable title, “Enough is enough: Stop wasting money on vitamin and mineral supplements.” The author’s comments were in response to three articles published in the same journal that explored the role of vitamin and mineral supplements for preventing the occurrence or progression of chronic disease.

These respected public health doctors made sweeping and conclusive statements like, “The message is simple: Most supplements do not prevent chronic disease or death, their use is not justified, and they should be avoided.” Researchers were looking for results that prevented chronic disease (ducks) among a pile of products intended to support overall health and wellness (geese).

To that point, it is true that dietary supplements are not silver bullets that completely replace poor diets, nor are they intended to have drug-like effects to prevent or treat chronic diseases. However, this does not discount that dietary supplements can be used in conjunction with modern medicine to supplement, optimize and improve the health of individuals with a disease. Furthermore, there is ample evidence that nutritional status is a strong predictor of post-operative outcomes, for example.

With that said, it is irresponsible for public health experts to make sweeping statements casting away all dietary supplements simply because the latest ill-conceived and poorly designed clinical study of a nutritional ingredient confirms the null hypothesis. When the Annals of Internal Medicine sends the message “enough is enough” and we should “stop wasting money,” this has a chilling effect on research funding. This message also ignores the fact that science grows in increments and new studies in different populations or different chronic diseases may have different outcomes.

We won’t hold our breath for the Annals of Internal Medicine to publish an editorial titled: “We got it wrong. Vitamin and mineral supplements improve cognitive function in older adults.” However, if such an article was published, it should explain researchers were premature to tell older adults to throw away their vitamins.

These researchers did not anticipate that in 2022 and 2023, two separate studies published from the COcoa Supplement and Multivitamin Outcomes Study (COSMOS) trial would provide high-quality evidence that a daily multivitamin may protect against memory loss and cognitive decline. In one study, the improvements detected are estimated to be equivalent to 3.1 years of memory changes related to aging.

These new studies do not show multivitamins are a drug or a nutraceutical that can prevent or treat Alzheimer’s disease. Instead, they demonstrate these products can preserve cognitive function and reduce the burden of dementia on families and society.

If you view the scientific evidence with the expectation that dietary supplements are not medication but rather “supplements to healthy eating,” or that not all cognitive decline is a disease, but rather a normal part of aging that is variable based on lifestyle, it begins to make sense how dietary supplements can be safely and effectively integrated into chronic disease risk-reduction for the best outcomes.

Now, it’s the supplement industry’s turn to say, “Enough is enough!” We need to actively manage expectations of what dietary supplements are—products that help support overall health and wellness—and what they are not—nutraceuticals.

Words matter, and, when it comes to dietary supplements, what comes out of our mouths is just as important as what goes in.

Naturopathic doctor Duffy MacKay is the senior vice president of dietary supplements at the Consumer Healthcare Products Association (CHPA), where he leads the association’s dietary supplement scientific, policy and legislative initiatives. His career in supplements spans more than 25 years and includes serving as a senior executive and scientist at leading dietary supplement companies, including CV Sciences, Nordic Naturals and Thorne Research.

Mike Tringale is the senior vice president of communications and public affairs at CHPA, where he is responsible for providing strategic direction and oversight for communications and key public affairs initiatives. His work in health communications spans more than 25 years and includes policy and research work at the Asthma and Allergy Foundation of America, the Brookings Institution, Georgetown University Medical Center and the University of Oxford.