October 2001
by Steven Novella, MD

Of all the issues that skeptics confront, many of which are heated and controversial, you would not think that blue-green algae would rank high among the concerns of those who write to the NESS. Yet we receive more e-mails regarding this specific topic than any other, a recent flurry of which prompting this article. The reason for this is partly idiosyncratic, since this is one of a select number of topics that we cover on our website. However even among our website topics it attracts seemingly undue attention. I have strong suspicions regarding the answer to this minor mystery, but first let us take a look at the blue green algae phenomenon.

The Claims

Blue green algae is a single celled plant that produces its own food through photosynthesis. Of the more than 1500 species, two – Aphanizomenon and Spirulina – are being harvested and marketed as capsules or tablets for their alleged health benefits. Spirulina first entered the public consciousness in 1981 when The National Inquirer published an article promoting it as the latest weight loss miracle. It has been sold since then by various companies. Cell Tech, a distributor of blue green algae products, claims that blue green algae is “a complete whole food,” which contains “60% protein with all the essential amino acids in perfect balance,” and “the highest chlorophyll content of any plant.” They further claim that the nutritional value of blue green algae “will provide health benefits by giving the body many of the nutrients it needs to return to balance and heal itself.” Specific health claims made for their products include: “improved mental clarity and memory, increased energy and vitality, improved sleep, relief from fatigue, hypoglycemia, some allergies, and poor digestion, weight loss, detoxification, and an overall increase in well being and stamina.” (Cell Tech 2001) They also imply that blue green algae can help prevent or treat cancer. Not bad for plain old pond scum. Although Cell Tech is not the only company making claims for Spirulina, the above claims are representative.

Proponents of Spirulina and other blue green algae products are quick to point out that scientific research supports their claims. One such study was published in December 200 in the Journal of Medicinal Foods by Dr. Eric Gerschwin at the UC David School of Medicine. Dr. Gerschwin summarized the study as follows:

“We found that nutrient-rich Spirulina is a potent inducer of interferon-gamma (13.6-fold increase) and a moderate stimulator of both interleukin-4 and interleukin-1beta (3.3-fold increase).” These are markers of immune function. The press summarized the study by stating that Spirulina “boosts the immune system.”

Dissecting the Claims

The primary problem with the health claims made for blue green algae is that they are not supported by any clinical research. This is so often the case that skeptics run the risk of sounding like a broken record. This lack of evidence problem is true for the vast majority of food supplements marketed with health claims, for reasons that we will explore below.

What about the plausibility of the claims, however? The claims are largely based on the notion that Spirulina is an ideal food, dense in nutrients and in perfect “balance.” However, Spirulina products are largely marketed as small capsules or tablets. As a food supplement Spirulina products contain negligible amounts of nutrients, and costs the consumer approximately $300 per pound. Spirulina contains no nutrients that cannot be found in other foods for a much reduced cost. Put simply, blue green algae products are typically not consumed as food but are taken in small amounts for their alleged drug-like health benefits.

It is also interesting that the promotions for Spirulina follow one of the classic paradigms of pre-scientific healthcare – that of balance. The idea that illness is due to forces, or some physiological functions, being out of balance, and that restoring balance will promote health is an idea that is thousands of years old. In Eastern culture is was the opposite forces of yin and yang that must be balanced (by acupuncture and other techniques), in Western culture it was the four humors that needed balancing, by blood letting, for example. Some modern alternative therapies have resurrected these ancient and pre-scientific ideas. In addition, this simplistic concept of balance has become the cornerstone of nutritional quackery.

Many of the fad diets of the past few decades have been based upon the idea that there is a magic formula of macronutrients – carbohydrates, fat, and protein – that will put the body into an ideal state, allowing for unwanted fat to melt away while reaping of host of other health benefits, such as increased energy. This philosophy was epitomized by the book, Enter the Zone, by Barry Sears. Like most misconceptions, there is a kernel of truth in such ideas. All nutritionists and physicians basically agree that a varied diet, with a good mix of different kinds of food, is better than a narrow or restricted diet. We do have nutritional needs, and there can be negative health consequences to a poor diet. However, there is likely a broad range of what is acceptable, and as long as our minimal requirements for each type of nutrient are met we will not suffer any nutritional health consequences.

At the other end of the nutrition spectrum, however, there is controversy, fed by a dramatic lack of any convincing evidence. Specifically, there is little evidence that large doses of any vitamins or minerals provides health benefits in addition so simply avoiding the effects of vitamin deficiency. There are only a very few situations in which supplements have proven to be of specific benefit, such as folate for pregnant women to avoid neural tube birth defects. Similarly, there is no evidence that a narrow “zone” of balance between the macronutrients has any health benefit, other than avoiding deficiencies or excesses in any one. Of the macronutrients the only one with proven harm from excess is fat – which carries with it an increased risk for heart disease and colon cancer. Although much press has been given to the theoretical harm of a relative excess of carbohydrates (as a fraction of total caloric intake, not in absolute amount), these have not been proven with clinical studies.

Another important aspect of the claims made for blue green algae is the idea that once perfect nutritional balance is achieved the body will be able to heal itself of whatever ails it. This is also a popular concept in alternative medicine, for two primary reasons. The first is practical – namely that products cannot claim to cure or treat specific diseases without Food and Drug Administration (FDA) approval, which requires going through the time and expense to prove scientifically that one’s claims are actually true. However, the FDA can be skirted completely simply by claiming that your product promotes the bodies ability to heal itself.

The second reason is philosophical, and is based on little more than wishful thinking. The idea that the body has an almost unlimited ability to heal itself is certainly very appealing, but not based upon modern concepts of biology and medicine. Certainly our bodies do have remarkable powers to fight infection, heal wounds, and stave off disease. However, our bodies are far from perfect machines, and they become less efficient and capable as we age. Also, diseases have a host of causes, and it is actually a vast minority of diseases that are nutritional in origin. There are diseases which are based upon, or exacerbated, by nutritional deficiencies, but there are many more that are not. But if you are selling a nutritional supplement, and you care more about profits than truth, then of course it is to your advantage to greatly exaggerate the role of nutrition in health and disease.

The sellers of blue green algae products also claim that it helps with “detoxification” of the body. This is another staple of modern nutritional nonsense. The idea is that the bodies perfect ability to heal itself is harmed by toxins in the environment, or produced by our cells, which then build up in the body, causing disease. Again, there is the kernel of truth – there are in fact toxins that are associated with specific diseases. However, many nutritional gurus use the concept in a vague sense, without ever demonstrating, or in many cases even mentioning, specific toxins, their effects, and that their products actually reduce them in the body. Rather, the word “detoxification” is used is if it were a panacea. Also, since it has no specific health meaning, claims for detoxification also nicely avoid any difficulty with the FDA.

Scientific Research

What about the claims by proponents of blue green algae that its health benefits have been demonstrated with scientific research? This represents another very common problem of veracity within the nutrition supplement industry (and in the broader alternative medicine community), that of confusing basic science research with clinical research. Basic, or bench, biological research involves working with chemicals or cells in the petri dish or test tube and performing research on animals. It does not involve humans, which falls under the category of clinical research.

The study cited above is a good example of basic research, demonstrating that Spirulina increases the presence of chemicals which are known mediators of immune function in cultures of immune cells. This is a good starting point for determining the direction of future research. However, it absolutely cannot be the basis of any clinical claims.

The problem is that basic research alone is a very poor predictor of the final health effects of a substance on the human body. Human physiology is far too complex to make such extrapolations with confidence, and the last century of medical research has demonstrated that only a very small minority of substances which look promising in the test tube actually prove beneficial to people. Carefully conducted clinical trials, in which the substance in question is given in a double-blind manner (where neither the subject nor the evaluator knows if the subject received the actual substance or a placebo) and specific health markers are followed are required to support health claims.

Claims that nutritional supplements “boost the immune system” are a favorite in the industry. However, this is not a scientific concept. The immune system is a complex system of the body. It fights off infection, foreign bodies, and abnormal cells, such as cancer cells. However, it does so at risk to the host itself. The inflammation caused by the immune system often causes more damage than the infection the inflammation is fighting off. Reacting to foreign substances, in many individuals, can be exaggerated to the point of life threatening allergies. Also, there is an entire category of disease known as autoimmune diseases, in which the immune systems attacks its own body. They include many chronic and serious illnesses, such as rheumatoid arthritis, multiple sclerosis, and lupus.

Because the immune system is a double-edged sword, any attempt at manipulating the immune system is also double-edged. Therefore increasing immune system activity is just as likely to be harmful to a person as beneficial. Therefore, even if the claims made for Spirulina based upon early basic research, that it increases immune activity, are true, they cannot be used as the basis for claims of health benefit, and in fact may be markers for potential harm.

Multi-Level Marketing

Blue green algae products are largely sold through multi-level marketing, which is a scam in and of itself. In such companies product distributors recruit new distributors and then are paid a percentage of their sales. In this way, a pyramid of distributors is formed with profits filtering up to the top. Those at the lower levels of the pyramid usually end up working for the benefit of those above them. They themselves cannot make significant money because the market is already saturated. This basic reality is why pyramid schemes are illegal, because “everybody benefits” only in a world with an infinite number of people. In the real world a few at the top benefit at the expense of the many at the bottom.

With questionable health products the multi-level marketing takes on a new aspect, namely that consumers become salesmen. The distributors of blue green algae use the product themselves. Those customers who are convinced through their own anecdotal experience that it is of benefit are easy to recruit as new distributors. They then recruit new customers, some of whom will also become distributors. At the bottom of the pyramid you mostly have distributors who are selling just enough of the product to support their own consumption.

Therefore, such multilevel marketing of questionable health products victimizes customers in two ways: by selling them products with unsubstantiated claims, and then recruiting then as distributors so that they can work for the higher ups in the company and make them even more profit. It also provides a sales force of genuine true believers. What better sales pitch is there than to say that one uses the product oneself. To a skeptic, there can be no evidence more worthless than the testimony of anecdotal experience by a salesman. Yet to the public such sales pitches can be very compelling.

This also brings me back to the mystery of why we receive such a disproportionate number of letters concerning blue green algae. It turns out that the letters almost entirely come from distributors, desperately trying to convince me of the benefits of their products. One company even solicited us for a link to their website, promising to give us a kickback for each referral, but I suspect they didn’t actually read our site and likely found it through an automated search for any websites mentioning blue green algae.

Regulation

The history of the sale of blue green algae is interesting and instructive. In 1982, K.C. Laboratories of Klamath Falls, Oregon began marketing blue green algae products under the brand name Blue Green Mana. Its president, Victor H. Kollman, marketed the products with a host of health claims. In 1983, the FDA began to investigate K.C. Laboratories, but it wasn’t until 1986 that a federal injunction was handed down by a U.S. District Court ordering K.C. Laboratories to stop all sales of blue green algae products. The judgment was based largely on the fact that the products were intended to be taken as drugs, not as food, and therefore marketing them with health claims was tantamount to selling a new and untested drug, violating FDA regulations (Barrett, 1997).

In 1982 Christopher Hills, founder of Microalgae International Sales Corp. (MISCORP) paid $225,000 to settle charges that he had marketed Spirulina with false heath claims. Although sales of blue green algae products continues, the FDA appeared to be doing its job of seeking out false health claims, prosecuting the offenders, and thereby protecting the public.

In 1994, however, this dramatically changed. In that year Congress pass the Dietary Supplement Health and Education Act (DSHEA). The act changed the rules so that the supplement industry could market products (herbs, food supplements, etc.) as dietary supplements and can make specific claims that the products promoted health. As long as no claims were made for curing or treating a specific disease, the supplement maker’s were safe. Therefore, one could say that St. John’s wort “promotes a healthy and positive mental outlook,” but could not say that it “treats depression.” A subtle distinction for the lay public to make, especially in the face of media attention that St. John’s wort is an alternative for treating depression.

The flood gates opened. Companies such as Cell Tech could sell the public dubious products with dubious claims without fear of prosecution. A quick search of the internet will find dozens of companies selling blue green algae products with the full spectrum of pseudo-health claims (CTI 2001, eg).

Conclusion

Blue green algae products are an excellent representation of what is wrong with the nutritional supplement industry. The products are marketed with a long list of health claims that successfully evade the greatly watered down power of the FDA to protect the public from false or misleading claims. Preliminary basic research is inappropriately used to support clinical claims, while no effort is made to actually study those claims. Although sold for its alleged nutritional value, it is packaged and used like a pharmaceutical. And questionable marketing techniques are used to turn consumers into distributors.

The existence of the blue green algae market and the behavior of distributors clearly demonstrates the need for new regulation. Specifically, the Dietary Supplement Health and Education Act should be repealed. In its place we need legislation that serves the interests of the consumer, and not just the industry. Supplements should not be subject to the same strict requirements as for new drugs, which would be both impractical and unnecessary. Rather, supplements should be required to be tested for safety prior to marketing, and no claims should be allowed, either on the label, in any marketing literature, or spoken verbally by distributors, unless they have been adequately proven in clinical trials.

References

1) Gerschwin, E. Journal of Medicinal Food, Vol 3 Number 4, Winter 2000
2) Barrett, S. Algae: False Claims and Hype. Quackwatch, 1997.
3) Cell Tech 2001 promotional website: www.celltech.com
4) Dietary Supplement Health and Education Act, http://vm.cfsan.fda.gov/~dms/dietsupp.html
5) CTI promotional website: www.sbgalgae.com

Filed under: Science and Medicine, spirulina