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Adrenal fatigue, alternative medicine, Bad GOOP Advice

GOOP’s physician branded supplements warrant a closer look

A few months ago GOOP rolled out their line of physician approved supplements. The very best supplements curated by experts direct to you for only $90 for one month’s supply or if you sign up for a monthly delivery only $75 a month.

The health claims that GOOP makes about these supplements were recently labelled deceptive by the advocacy group Truth In Advertising. For example, Truth in Advertising took issue with the claims that the “Balls in the Air” supplement can target autoimmune diseases. Look, I don’t even know what targeting an autoimmune disease means and I am a doctor. Possibly that’s a legal term for getting around an actual health claim or maybe it reflects the precision of this untested product? Who know?

Three of the doctors with GOOP branded supplements, Junger, Gottfried and Myers, all practice in the United States and so it is worth looking at their endorsed supplements with a view to any statements from American professional medical societies regarding these kinds of ventures as well as any financial ties.

What do Professional Societies Say? 

The American Congress of OB/GYN (ACOG) has perhaps the strongest policy statement of any medical speciality on the matter, which I find justified as women are often the target of “hormone cures” that don’t exist and weight loss scams. For example, GOOP specifically markets the non existent adrenal fatigue to women and of course the supplements to treat it under the guise of feminism. The ACOG August 2017 Committee Opinion on Commercial Enterprises in Medical Practice says self-referral, a physician recommending a product or service in which they have a direct financial stake, is something to be discouraged.

ACOG also states the following:

  • Obstetrician–gynecologists should not sell or promote agents or devices as being therapeutic without an adequate evidence base for medical benefit.
  • Obstetrician–gynecologists should not use their professional influence or clinical environment to sell or promote nonmedical products or services or to enroll participants into multilevel marketing schemes.
  • The sale of prescription or nonprescription medication or devices directly to patients from obstetrician–gynecologists’ offices is discouraged when reasonably convenient, alternative vendors exist.

This statement is particularly relevant as Dr. Sara Gottfried, who designed the GOOP  “High School Genes” supplement, is an OB/GYN and is listed on the ACOG website as a fellow. Dr. Gottfried also has a wide range of personally formulated supplements and shakes on her website and claims her products have worked  “gloriously well on the 10,000+ people” she’s seen in the past 10 years although it is hard to see how that would count as medical evidence or unbiased.

The American Medical Association (AMA) also has pretty clear views on the matter. They state the following:

Physicians who choose to sell health-related products from their offices should not sell any health-related products whose claims of benefit lack scientific validity. When judging the efficacy of a product, physicians should rely on peer-reviewed literature and other unbiased scientific sources that review evidence in a sound, systematic, and reliable fashion.

There is no evidence GOOP supplements are scientifically valid and in fact they could potentially harm. 

None of GOOP’s specific supplements have been tested in a sound, peer-reviewed fashion although some of the components have been addressed in studies.

There is large body of medical literature indicating supplements do nothing and may even be harmful. Multivitamins and supplements are not going to help you reverse aging, hack your genes (what ever the fuck that means, like really?), or help you safely lose weight. In fact you may be more likely to die if you take anti oxidant supplements.

There are studies suggesting vitamin A supplements may increase the risk of some cancers and this is relevant to the GOOP products as they contain a fair bit of Vitamin A. According to the National Institutes of Health Office of Dietary Supplements  in addition to a potential cancer risk  excess vitamin A from supplements can lead to liver damage and “increased intracranial pressure (pseudotumor cerebri), dizziness, nausea, headaches, skin irritation, pain in joints and bones, coma, and even death.” It’s not as if GOOP and their physicians are unaware of this as they actually have a vitamin A disclaimer.

For the record the recommended dietary allowance (RDA) of Vitamin is A is 700 mcg a day of retinol activity equivalents (RAE) for women who are not pregnant or breastfeeding. One sweet potato gets you about 1,400 mcg but where’s the profit in that?

“High School Genes” and “Why am I so Effing Tired” (a.k.a. Ode to Paltrow) each have 5,000 IU of Vitamin A and “Balls in the Air” has 10,000 IU.  In each product the vitamin A is supposed to be equally divided between beta-carotene and retinyl acetate or retinol.  According to the NIH Office of Dietary Supplements there is an association between > 1,500 mcg daily of preformed vitamin A (i.e. retinol or retinyl acetate) and reduced bone mineral density, and increased fracture risk. If I did my math and chemistry correctly (1 IU of retinol is 0.3 mcg retinol activity equivalents or RAE) the 5,000 IU of retinyl acetate in  “Balls in the Air” is 1,500 mcg of preformed vitamin A. Yikes.

It’s not just the retinol that has health concerns according to the NIH the beta-carotene in supplements may increase the risk of lung cancer and heart disease.

Really, eat a sweet potato or have some pumpkin pie. Tastier, safer, and cheaper. That’s not alternative medicine it’s just medicine.

 

Dr. Junger’s “Effing” product has an even a more frightening disclaimer:

 

Glycyrrhizic acid is a licorice derivative and studies showing ingestion of over a 100 mg a day can raise blood pressure. “Effing” claims to have 300 mg of licorice root with 75 mg of glycyrrhizic acid. I guess it’s up to you whether you trust the GOOP chemists or not. I’m not sure how Junger decided 600 mg a day was safe. Maybe this is why Paltrow is so unwell? Could Junger have her jacked up on licorice?

The supplements branded by the three American based doctors also contain green tea leaf extract which in high doses is associated with liver injury. It is hard to know how much is actually in the product as this is a propriety blend, however, the concern is so great that liver specialists specifically advice against all supplements with green tea extract even in blends. It ain’t worth the risk.

 

GOOP, Doctors, and Big Supplements

Every concierge doctor with a wellness shop and a side venture in shakes wants you to be scared of “western” medicine because we evidence based doctors are apparently all in the pockets of Big Pharma. It’s drugs drugs, drugs! Okay some obviously are but most are not and you can and should look up those conflicts of interest. However, there is also Big Functional Medicine and there is no ProPublica website where you see how much money doctors are making from selling supplements or lending their professional influence to GOOP. Did the doctors who designed these supplements for GOOP get a lump sum? Do they get a percentage? Is this all just for the privilege of being featured on GOOP?

There no peer review evidence to suggest any of the GOOP physician branded supplements do anything and they could have risks. These supplements also don’t appear to fit ACOG and AMA guidelines as appropriate for promotion by physicians.

Dietary supplements are only indicated when there is a true nutritional deficiency and invented  conditions like sluggish thyroid, adrenal fatigue, and postnatal depletion simply don’t count. In fact, they are offensive marketing terms in my opinion.

I’m always amazed how functional medicine doctors claim to promote healthy living and natural lifestyles and yet that living appears to be rarely achievable with, you know, food.

Me, I’m going to make pumpkin muffins tomorrow.

Discussion

24 thoughts on “GOOP’s physician branded supplements warrant a closer look

  1. Thanks for the science!

    Keep up the good work.

    Posted by The Professional Scold | August 25, 2017, 3:33 am
  2. Simples : If it’s expensive it must be good . /s
    If you buy from Goop please read the Disclaimer ( in other words , if it diesn’t work , you don’t get your money back ) .

    Posted by Jim | August 25, 2017, 3:44 am
  3. I always look forward to your posts.

    Posted by kathylcsw | August 25, 2017, 4:43 am
  4. How are they getting away with all this BS?

    Posted by Jaci | August 25, 2017, 5:29 am
  5. Those product-specific disclaimers are just amazing. To someone who understands them, they read as, “you probably shouldn’t take this.” So their lawyers are pretty sure they’re covered against against claims of overdose or other harm. But I think they’re counting on the general tendency for people to skip reading those, not understand them, or otherwise dismiss them. After all, anything with a warning label must be the strong stuff, right?

    And it looks like anybody taking “High School Genes” or “Why am I so Fing Tired” should probably avoid any dietary sources of vitamin A.

    Posted by madder | August 25, 2017, 7:11 am
  6. Thank you! I’m saving this to use with clients.

    Posted by Vanessa Oliver | August 25, 2017, 7:45 am
  7. I hope someone sues the pants off them.

    Posted by RCraig | August 25, 2017, 8:44 am
  8. Yes! I am so discouraged by the uptick in “functional medicine.” I don’t see people getting better, I see people spending hundreds of dollars a month on useless supplements. The lack of evidence on the efficacy of these supplements is astounding. Always fix the food first, and the lifestyle, and then supplement if there is a deficiency or a need.

    Posted by Denise Canellos | August 25, 2017, 11:02 am
  9. Thank you for yet another excellent post – you are not only a voice of scientific reason and intellectual honesty, but also a very skilled and entertaining writer and a GREAT PUBLIC SERVANT. Many thanks and keep up the great work.

    Posted by Dr. John | August 25, 2017, 11:09 am
    • 😳 thanks

      Posted by Dr. Jen Gunter | August 25, 2017, 11:56 am
    • Agree. I see this crazy dangerous stuff every day. Fortunately most of my patients bring the bottles in and ask me if they are alright. I tell them to return them or throw them out if they are open and live a healthy lifestyle. I give them a diet with food not useless or harmful pills and an exercise program. This was a great post. I reposted it to Facebook. Thanks. Joann Urquhart MD

      Posted by Joann urquhart | August 29, 2017, 6:11 pm
  10. I stopped taking multivitamins when I read the highly credible studies that found they cause harm. The only vitamin I take is D3 and sometimes a low-dose iron since I can occasionally get anemic. Everything else I try to get via food. Has anyone thought of buying the Goop supplements and having them tested at a lab, to check their actual ingredients? It seems the supplement industry can pretty much claim anything without much oversight.

    Posted by JMJ | August 25, 2017, 11:42 am
  11. I am learning new stuff daily … and be sure to throw some of those “magic weight loss walnuts” in to your pumpkin muffins!

    Posted by Sheila | August 25, 2017, 1:26 pm
  12. Hi,

    I’m a fan of your blog and I think you’re doing some really valuable work in exposing the bogus health claims made in the weird world of goop.

    Something caught my attention in your latest post and I really wanted to know if you could expand a bit on it. You say that adrenal fatigue, amoung other “conditions” are not real. A few years back I went through an extremely debilitating period of ill health following a very intensely stressful period in my life. The doctors who I saw we unable to give me any kind of diagnosis or treatment that was helpful and it was out of desperation that I began searching online to try and find some kind of answers. The symptoms I was experiencing matched extactly all the various different accounts of adrenal fatigue. Now I totally appreciate that these accounts were not necessarily medically verified or based on proper research. But can it be that there are areas of women’s health that are not yet fully interstood or for whatever reason the reasearch is yet to be done into some of these kind of extreme fatigue type conditions? I have no idea if ‘adrenal fatigue’ is real or not but I do know that my experience was real. What do we do in these situations where conventional medicine has little to offer and doctors are sometimes dismissive? I can see that for some vulnerable/gullible people this could lead them down the path to goop or other more benign (and perhaps better intentioned ) organizations.
    I agree that there is a huge amount of cashing in but I also think there is a lack of genuine help and understanding of the very real health problems that many women face.
    I would love to know what your opinion is.
    Thanks and keep up the good work !!

    Poppy

    Posted by Poppy Da Costa | August 26, 2017, 2:57 am
    • Almost anything could be made to fit such a huge list of generalised symptoms, people end up not going and getting a proper diagnosis if they get this bogus diagnosis first which leads to longer term problems. Adrenal glands don’t work like that and nor are they specific to womens health. This post should explain the lack of evidence behind “adrenal fatigue” in more depth for you: https://sciencebasedmedicine.org/adrenal-fatigue-a-fake-disease/

      Posted by Bendy Beauty | August 29, 2017, 10:05 am
    • I used to have a large degree of respect for MDs (my Grandfather was one). Experience has shown me that not all doctors are created equal. Many specialists do not keep current on treatment options or have the grace to say “I’ll check on that” to the detriment of their patients. I had Graves thyroid disease that was treated with radioactive iodine. The yo-yo of high/low of replacement Eltroxin was likely contributory to the pre-mature birth (26 weeks) and subsequent loss of my daughter at 10 days (yes I belong to that sad sorority). When some of my other children started to have thyroid symptoms, TSH testing showed elevation but at the borderline of treatment for general population at the time. It is interesting to note that woman pregnant or trying to get pregnant have a TSH high cut off of 2.5 instead of the 4 or 5 value used for others. Do others not get to feel well? Guess I shouldn’t complain as the current TSH cut-off reduction, from a previously higher one, finally allowed my children to get treatment. Dosages are the current hurtle.

      I have also had a parathyroidectomy due to 3 adenomas (elevated PTH, borderline high calcium). The operating endocrinologist stated that it was a potential complication of the radioactive iodine (no warning of that complication at the time even though known) and that kidney function was not compromised signficantly so my calcium level did not sky rocket. I had to travel to the US and pay for adenoma removal because available endocrinologist said “I wasn’t that bad.” Guess being unable to work wasn’t bad enough, I should wait for worsening osteoporosis or kidney failure even though only treatment is surgery! Ironically, I am thankful that surgery was not done here as they would have missed the third adenoma that Dr. Norman (Tampa) tested and removed. It wasn’t the testimonials on his website but the studies and affiliations attached to his resume that convinced me he was a legitimate option. I did advise the local endocrinologist of my treatment, surgeon and outcome … hopefully, she pays attention for the benefit of her future patients.

      My point of all this background is MDs are not infallible. What does the average person do when faced with these types of problems that doctors & specialists disregard? While not technically true it fits the situation … “The definition of insanity is doing the same thing over and over and expecting different results.” Patients left in limbo for years do try to seek answers elsewhere when the medical system fails them…

      Posted by Diane | September 5, 2017, 3:07 pm
  13. There is some hope. Truth in Advertising Inc has filed a complaint with the California Food, Drug and Medical Device Task Force about unsubstantiated health claims made by Goop. Some details are on the Slate website:
    http://www.slate.com/blogs/xx_factor/2017/08/24/goop_could_face_consequences_for_making_deceptive_health_claims_about_its.html

    Posted by Paul Manson | August 29, 2017, 6:51 am
  14. “There is large body of medical literature indicating supplements do nothing and may even be harmful.” I’ve personally seen literally hundreds of clinical trial publications reporting positive results for various botanicals. The idea that natural products aren’t bioactive when benefit is involved, but only when risk is involved, is unlikely enough to be fundamentally a religious belief. For example, high-dose green tea supplements do cause liver problems in some people, but it is obvious from the label of the product in question that the dose there can’t be very high, and green tea has a number of likely or indeed proven health benefits. I am no fan of the overpriced Goop products, but MDs who suggest that “supplements” as a class have no benefits, for readers who know that that is false, call all of their other advice into question. I advise you to stick to giving advice in your own area of expertise.

    Posted by jane | August 29, 2017, 7:02 am
    • Hi, Jane. Your advice to stick to your own area of expertise is questionable since you don’t list any of your own credentials or qualifications that suggest you are more qualified than Dr. G to do so. Also, just because certain botanicals might have some limited benefits doesn’t at all mean that the concentrated chemical compounds that are sold as ‘nutritional’ are anything close to the ‘natural’ products they are purported to contain. Because these are supplements the manufacturers are not compelled to prove that ANY of the statements listed on the label are actually true– this includes the ingredient list as well as things that may be there but are not disclosed. As a Registered Dietitian and Certified Diabetes Educator myself, I too often see people who hold the religious-like belief in the idea of taking a few little tablets a day will make you live a longer, healthier life despite the fact that, as Dr. G mentioned, there is NO EVIDENCE to back it up (along with some compelling evidence to the contrary). I say kudos to Dr. Jen Gunter for taking a principled stand against those physicians who use their credentials to line their pockets at the expense of those who would blindly trust them.

      Posted by Cindy | August 29, 2017, 10:25 am
  15. As a practicing cardiologist for over 31 years,I would like to let you know that seeing your link on Medscape and reading your blog was like a breath of fresh air, and a ray of hope. I would also confirm that many patients and people from all walks of life often spend a tight budget on supplements, sometimes when they cannot afford their blood pressure or cholesterol medications. It appears that a multi-billion dollar rip- off is being allowed to take place and the American public is being fleeced. Accurate information is being sabotaged by a huge advertising effort mounted by the supplements business and industry, as well as by high visibility and sometimes famous and beloved profiteers! Thank you for your efforts!
    Franklin Zalman MD, FACC, Medical Director of Cardiovascular Disease Foundation, San Diego and Monterey California

    Posted by Franklin Zalman MD, FACC | August 29, 2017, 9:04 am
    • Let me second that, and Cindy’s astute comments as well. The unvarnished truth here is that the purveyors of these unvalidated remedies are PREDATORS – be they physicians, other health professionals, celebrities, or just dedicated hucksters. It is this predation that Dr. G has taken a stand against on principle – and it goes far, far beyond Goop. It is a very good thing that there is open and honest dialogue on this, thanks to Dr. G.

      Posted by Dr. John | August 29, 2017, 7:22 pm
  16. It never ends.
    And never will.

    Posted by John Agnew | August 29, 2017, 3:11 pm
  17. Dr Jen, I’ve just found your blog and you’ve restored my faith in commonsense. Good on you for taking on the entitled idiocy, wilful money grabbing and priveleged arrogance masquerading as feminist empowerment that is GOOP. I love your writing style, your guts and your commitment to fighting misinformed bullshit with evidence and logic – two things GOOP’s acolytes are eternal strangers to. In short, you rock. Keep fighting the good fight. Behind you all the way.

    Posted by Simone Malcolm | September 5, 2017, 12:49 am
  18. It’s really helpful to read this stuff. I get swept away with the lure and promises of the goddamn mRketing.

    >

    Posted by Neg Mahmoodzadegan | September 14, 2017, 5:53 am

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