Please Don't Eat the Nano Soccer Balls

What level of evidence should we expect before we take a supplement? How I start to learn about health claims.

When old guys like me learned chemistry and physics in school, pure carbon existed in two remarkably different forms: graphite and diamonds. But in 1985, a third form of carbon was synthesized: Buckyballs. The “fullerene” class of nanometer-sized balls (and later, nanotubes) were given their name by the inventors, recognizing an interesting old character named Buckminster Fuller (1895-1983). Fuller was an inventor who became most famous for his geodesic domes -- stable, strong structures constructed out of polygons, resembling half a soccer ball. Since the structure of the newly created carbon nanoparticle C60 resembled a soccer ball, it was given the name “buckminsterfullerene,” and the nickname "Buckyballs." The 1996 Nobel prize in chemistry was awarded for this discovery.

As a science nerd, all this I pretty much knew. What I didn't know until a friend asked me about it is that now there are people and companies claiming it's a good idea to ingest these carbon balls. I can imagine a dozen ways that these little specks of carbon might cause trouble, and so my initial instinct was that if we are gonna worry about microplastics in the ocean, in our food supply, and in our bodies, then probably we would have at least the same level of worry about C60 nanoballs. But maybe I was missing something, so I did a bit of reading.

How can a thinking person learn more about a health claim? If you’re like me, you’re open to new ideas but you want to find information that is trustworthy. When I want to spend a little time looking into the safety and health effects of something, I don't find it very useful to ask Google "is C60 [or whatever] good for you?" There's a lot of bullsh*t out there. Google Scholar can be a little better -- this is a tool for searching the published scholarly literature. Unfortunately the explosion of predatory journals, merely bad journals, and pseudo-science journals, and of the scientists and pseudo-scientists who publish in them means that there is a tremendous lot of bullsh*t in the "scholarly" literature as well. And of course, once you’ve shown some interest in a topic or a product, the algorithms that drive internet advertising will show you more and more sponsored material telling you to buy it.

If you want to get really deep into the weeds you can try to figure out whether the scientific publications you find are in high quality peer-reviewed journals, by checking the journals’ "impact factor." (In general, journals that publish papers which are then cited by a lot of other research papers are considered higher impact, a marker of higher quality.) But this is a lot of work and is not a quick way to get the answers you are looking for. Furthermore, the good papers in the high quality journals are often locked behind unreasonably expensive paywalls, essentially blocking you from reading them unless you are a university researcher yourself.

People have strong feelings these days about trust and mistrust for institutions like the Food and Drug Administration (FDA) but they do have a lot of scientists working there who know how to do the leg work of assessing the quality of research claims. Are there any reports of FDA warning supplement makers to stop claiming C60 is good for you? Yes, there are.

Are there any reports from the Scientific Committee on Consumer Safety (SCCS) of the European Union? There are.

“But wait,” you might say. “It’s not a drug, it’s a supplement, and the bureaucrats at the FDA shouldn’t be all up in their business.”

OK, I’ll bite. What’s the difference between a drug and a supplement? I’d argue that the difference is almost entirely about how they are regulated, and very little about what the stuff is supposed to do.

In the US, drugs need FDA approval to be sold. This approval is gained only after the drug has demonstrated both safety and efficacy, through clinical trials. Ingredients, manufacturing processes and facilities, and marketing claims are closely regulated.

Dietary supplements, in contrast, do not need FDA approval before marketing. Clinical trial demonstration of safety and efficacy are not required. Manufacturers are responsible for ensuring the product is safe.

This distinction makes me more cautious. Supplements’ carefully-phrased marketing materials often suggest powerful health benefits, but by avoiding certain language they avoid the regulatory hurdles that drugs must pass. Before doctors prescribe or recommend a drug for patients, we expect that the drug has been tested enough to give confidence that it has the desired effect in humans and does not cause unwanted side effects. As I’ve written before, an experiment in rats counts for about zero points towards this confidence. Supplements dodge this expectation, but this is for historical reasons, not scientific ones.

If C60 does just one or two of the good things that are suggested by the people who want to sell you some, then I would call it a very powerful drug indeed. And I don't know of any drug ever since the beginning of time which is all upside and no downside. If you believe the stuff actually does something, then I’d argue you must consider it in these terms, of both potential benefit and potential risk. That's why the standard I want is demonstrated SAFETY and EFFICACY -- both -- before I think about recommending something. Experiments in rats don’t do it, except to lead eventually to carefully done safety studies in closely monitored human subjects (Phase 1 studies), followed by additional studies (Phases 2 and 3) in patients with a disease that needs treating. For C60 I don't really see evidence of either safety or efficacy in well-done human studies. But there's some concerning stuff about what it might do in the brains of fish who are exposed to it. And yes, there is a paper that says rats lived longer when they ate C60. Nonetheless, you'd have to pay me about a million buckies to try it!

It is so easy to sell health shortcuts. Just come up with a scientific-sounding explanation of how your magical pixie dust works “at a cellular level” to “combat aging” or to “support your immune system.” Cite some third-rate research articles in low-reliability journals. Make some glossy ads, engage a few influencers, and Boom! you’re selling a product.

As a physician scientist who is trying hard to maintain peak athletic and mental performance as I age, I have looked — and I don’t see any shortcuts. Eat well, exercise hard, sleep well. Take care of yourself and the people and world around you. And save your attention and your money – let the supplement industry find someone else to be their fool.