Scam or Not?

Is this product a scam? I often get emails that start off with that query. The reference is usually to some dietary supplement the questioner encountered on the Internet that promises to miraculously solve some health problem. This week the question was about EMMA, “the first and only Doctor Endorsed Formula that targets bacterial overgrowth, parasites and pathogens while strengthening the microbiome.”

In this case the “Doctor” turns out to be Dr. Gina Sam who judging by her educational background is certainly a qualified gastro-enterologist. However, that doesn’t make her immune to trying to boost her income with a little side venture, in this case endorsing EMMA with promises to “give your gut a vacation.” Not sure what that means, but it seems to have something to do with pooping easily every day and “pooping out up to 10-15 pounds of bloat” in the first month of use. I wonder how the good doctor, who is said to have developed the product, went about measuring that amount of “bloat” whatever that may be. Unfortunately, a plethora of physicians do get enticed by easy cash for hyping some supplement, really reputable ones do not engage in promoting such products that often have a shady side.

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Let’s try to shed some light on the shady world of dietary supplements. To start with, such products are very loosely regulated, to say the least. While prescription drugs have to be backed by extensive studies, dietary supplements in Canada can be sold with evidence that would not pass muster at a high school science fair, and in the U.S. can be marketed with no evidence at all.

A common scheme is to dredge the scientific literature for some study for some natural substance that has been shown in some way to have some sort of physiological activity. That isn’t hard to do because just about anything when tested in the lab or in an animal will have some sort of effect, sometimes positive, sometimes negative. Then cherry pick the positives and plunk those ingredients into a pill or capsule, along with some vitamins and minerals for good measure, and claim the product is “science based.” While there may be some evidence for some of the components, although usually not at the dose found in the supplement, there is no evidence for the supplement as a whole since no trials have been run. Therefore the “science-based” claim is bogus. It doesn’t mean the supplement cannot work, just that there is no evidence it does. Of course, there will be all sorts of anecdotes from people who claim that their miserable life has been turned around by the doctor’s miraculous discovery, but in terms of science, that doesn’t amount to a hill of beans.

In the case of EMMA, which is aimed at people who “struggle with digestive health,” whatever that may mean, nineteen ingredients have been assembled. When it comes to such supplements and their list of ingredients, the more, the merrier. And people don’t pay much attention to amounts. For example, EMMA contains 50 mg of chicory root inulin, and indeed inulin is a type of fiber that can soften stools and increase bowel movement frequency. But at a dose of several grams a day, not 50 milligrams! The same goes for deglycyrrhizinated licorice. There is some evidence for anti-ulcer effects, but at doses of grams per day, not 50 mg.

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In summary, EMMA is one of the thousands of dietary supplements that are promoted without sufficient evidence and hope to snare people who believe in the “natural is better” myth and are seduced by references to supposed ancient wisdom. Just because some herb has been used for thousands of years does not mean it has been used effectively. The placebo effect is very powerful, something of which supplement marketers are very much aware. It is discouraging to see qualified physicians, into whose brains in medical school we have tried to drill the importance of evidence, get into bed with marketers who with their clever language and cherry-picked data manage to pull the wool over people’s eyes.

So, to address the original question. EMMA isn’t exactly a scam since it is not possible to say that it is totally useless, but it is deceptively marketed because no proof is offered for the claim that the product “targets bacterial overgrowth, parasites and pathogens while strengthening the microbiome.” I suppose it would be difficult to challenge that statement on legal grounds since it only says “targets” without claiming that it actually hits the target. That kind of word play is common in the supplement industry. Furthermore, “doctor endorsed” is legally meaningless but suggests that there is evidence of efficacy, which has not been demonstrated.

@JoeSchwarcz

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