March Badness, Part 1: The Worst Supplements — Placebo Region

It’s March, which means March Madness, when basketball fans everywhere fill out brackets and pretend they have even the remotest chance of predicting the games. In the spirit of the NCAA tournament, I decided to create a bracket of my own. Instead of college teams, however, this one features some of the worst dietary supplements on the market competing for the title of March Badness.

The contestants are divided into two regions: products that can’t possibly work, and products that might send you to the emergency room—or even to a liver transplant center.

Let the games begin.

PLACEBO REGION 

• Prevagen

The makers of Prevagen ask consumers to believe that a jellyfish protein survives digestion, enters the bloodstream, crosses the blood–brain barrier, and magically enhances memory. All of this is correct, except everything.

Unless specially formulated, proteins (aka food) break down into the same amino acids they were built from. Even if there were biological plausibility for jellyfish to have great memories, it wouldn't matter. It can't possibly work. But what about all the "evidence" from those cloying TV commercials? Fuggetaboutit. 

Prevagen’s marketing relies on testimonials rather than medicine. Commercials feature sincere-looking paid actors describing dramatic improvements in memory, presenting personal opinions in a way that implies the product has strong clinical support. These anecdotal stories are nauseatingly effective in making viewers think they’re seeing evidence, when in reality they’re just scripted endorsements from people who say just enough to convince you to buy the crap, but not enough to get into trouble [1].

FanDuel odds - 3:1

• Oscillococcinum

Oscillococcinum is a very popular homeopathic flu remedy made from diluted duck heart and liver. While it's not at all obvious why duck guts would be useful for flu, it doesn't matter what it's made from. Diluted bowling shoes? Fine. Diluted bus tires? Super! Diluted nail clippings? Even better! The reason why none of this matters is the same reason I keep writing diluted.

That's because Oscillococcinum is typically diluted to 200C. Huh? In homeopathy, each “C” represents a 1-to-100 dilution repeated sequentially, so 200C means the process has been repeated two hundred times, producing a dilution of 10⁻⁴⁰⁰. By comparison, Avogadro’s number tells us that once a substance is diluted beyond about 10⁻²⁴, it is unlikely that even a single molecule of the original material remains. At 200C, the dilution is so extreme that the odds of any duck, bowling shoe, or nail clipping ever making it into the bottle are zero, perhaps less. And the perversion of homeopathy is that the more dilute a solution, the stronger it is. 

Crazy city.

FanDuel odds - 3:5

• Arnica

Homeopathy makes a second appearance in the bracket with arnica, a product widely sold for bruises, sore muscles, and minor injuries. Arnica comes from Arnica montana, a yellow flowering plant related to sunflowers that has long been used in topical herbal preparations. Real arnica extracts contain biologically active compounds and can even be irritating or toxic if swallowed, which is why they are normally used only on the skin.

Homeopathic Arnica is another story.

Instead of containing meaningful amounts of the plant, the homeopathic versions are typically diluted to 30C—far beyond the point where even a single molecule of the starting material is likely to remain. Yet it’s sold as if it contains anything useful, rather than a tiny pill containing a little sugar.

Some believers argue that if a preparation fails, it’s because it was insufficiently diluted.

Some believers also think that Elvis is hiding in their waffle iron.

Let's hear it for Prevagen. It's safe! You only have to take it once a day! It has a unique ingredient! So does a plutonium bomb. Does it do anything useful? Careless omission?

Whole Foods Alkaline Water.

The final seed in the Placebo Region comes from the world of alkaline supplements, pills, and powders that promise to “balance your body’s pH.” According to marketing gobbledegook, modern diets make the body too acidic, leading to fatigue, inflammation, and disease. There are also claims that acidity promotes cancer. The solution, naturally, is to buy something that supposedly makes you more alkaline.

Unfortunately for the supplement industry, human physiology already solved this problem a few hundred million years ago.

Blood pH is tightly regulated by the lungs and kidneys, which maintain it within a narrow range of about 7.35–7.45 regardless of what you eat or drink. If it drifts even slightly outside that range, you don’t need a supplement—you need a doctor. No pill, powder, or alkaline water additive can meaningfully change blood pH without also causing serious medical trouble, for example, death.

In fact, it can’t even survive the stomach. When the bicarbonate in this useless water encounters gastric acid (pH ~2), it undergoes an acid–base neutralization reaction—one of the fastest reactions in chemistry—and is destroyed almost instantly. Hello, Whole Foods checkout lane. Bye-bye $4.00.

FanDuel odds – 10:1

The Final Four

It was a hard-fought three games. 

In the first semifinal, Oscillococcinum faced Whole Foods Alkaline Water. The homeopathic favorite relied on its trademark strategy of having absolutely nothing in it, which proved difficult to defend against. Alkaline Water tried to mount a comeback, but the stomach shut that down. Oscillococcinum quacked out an 87–85 overtime win to reach the finals.

In the other semifinal, arnica took on Prevagen. Prevagen opened strong with its famous Jellyfish Memory Offense, but the playbook fell apart under even light defensive pressure from basic biology. Arnica pulled away in the second half and ran Prevagen out of the gym, 104–79, although no one could remember the final score. Perhaps the Prevagen could have come in handy.

Nah.

Next up: A look at the Emergency Room Region and the finals

NOTE:

[1] In 2017, the Federal Trade Commission and the New York Attorney General charged Prevagen’s manufacturer, Quincy Bioscience, with deceptive advertising, alleging that its claims that the supplement improves memory and cognitive function were false and unsubstantiated. Tsk tsk.