Xand van Tulleken on the 3 wellness trends to be most wary of

In 1893, a cowboy named Clark Stanley killed hundreds of writhing rattlesnakes at the Chicago World’s Fair. He then tossed them into a boiling vat and scooped up the rendered fat to sell as his now-infamous snake oil, which he sold as a tonic for all manner of health problems. This particular scam wouldn’t work today, but discerning quackery from legitimate medicine has become, if anything, even more of a challenge. To add to the confusion, healthcare advice often has to compete with the vaguely defined wellness industry, which, thanks to the rise of influencers and social media, is highly persuasive. Doctor, writer and presenter Xand van Tulleken turns his attention to this unregulated industry in Make Me Well: A quest to understand the confusing world of wellness. He spoke to New Scientist about his findings, revealing what does – and doesn’t – keep us healthy. Advertisement Grace Wade: What exactly is “wellness”? Xand van Tulleken: Wellness is about the way we feel. It is about increasing our performance, optimising our bodies and, to a degree, reducing our risk of disease. But wellness practices are not healthcare. What is the distinction? I always thought of wellness as optimising health. The modern wellness industry really tries blurring the boundary between health and wellness. It is the reason I wrote Make Me Well, because I was struggling to distinguish between the two. Health is typically about a defined problem that is measurable, and healthcare aims to prevent and treat specific conditions. Wellness, on the other hand, tends to work on things that are more slippery, that are harder to pin down. It is about feeling your best, optimising your performance, looking better. The wellness industry isn’t allowed to claim its products can treat medical problems, with the exception of some tightly regulated scenarios for certain supplements, such as that vitamin C contributes to the reduction of tiredness and fatigue. But all the restrictions on advertising and marketing and labelling don’t restrict influencers from giving their opinions. Another way to think about it is that healthcare is interested in the floor, while wellness is interested in the ceiling. Healthcare wants to stop you from falling below a certain level. Its aim is to keep you within normal range. Wellness dangles your best self out in front of you. It asks you to imagine the ceiling of how you can feel. Are there any wellness products that improve health? Becoming the best version of myself certainly sounds appealing. I focused on three areas of wellness: supplements, wearable technology and the testing industry. The hallmark of these products is that they look like medicine, but they aren’t. For almost everything, when I dug into the evidence, it evaporated. None of these products are intended to treat, diagnose or improve any disease or health condition. There is no testing for efficacy or safety. The wellness industry doesn’t have to prove efficacy, because it doesn’t claim these products do anything. Of course, it is very clever at making health claims through routes that aren’t legally scrutinised. You can’t put a health claim on a vitamin bottle, but you can get a podcaster to say it. Is there any harm in trying these products, like vitamins, for example? Yes, you need vitamins. But you don’t need vitamin supplements. That is one thing I feel strongly about: vitamin supplements don’t work for healthy people. That was hard for me to come to grips with, because it went against my intuition. Doctors, including myself, were on board with supplements for a long time. We assumed they were completely safe and that your body could manage excess fairly well. But then these big trials in the 2010s revealed that multivitamins aren’t associated with a reduction in death from any major health condition. And specific antioxidant supplements can actually increase mortality by roughly 4 to 16 per cent, depending on the exact vitamin and dosage. Antioxidants seem to increase cancer risk by shielding cancer from destruction, but I don’t know why large quantities of fruits and vegetables don’t pose the same risk. For some reason, our bodies seem to process the nutrients quite differently. Now, vitamins are a fantastic way of addressing specific health problems, and doctors use them to treat different illnesses. You have beriberi? That is a vitamin B deficiency. You have rickets? That is commonly vitamin D deficiency. But if you have a vitamin deficiency, you need to see your doctor. That is not a place where the wellness industry should be interfering. If you are low in iron, your doctor won’t just prescribe you a supplement. They will also ask why. Do you need a colonoscopy? Do you have pernicious anaemia? Is your menstrual cycle irregular? There are different ways to think about the problem that a doctor is incentivised to look for that a company selling supplements isn’t. What about at-home tests? It seems like it would be useful, not harmful, to screen for deficiencies and illnesses. The testing industry sells tests for cancer, menopause, hormones, vitamin deficiencies and so forth. Yet there is good evidence that blindly screening for disease doesn’t save lives and can actually make people less healthy. As an example, there was a large trial of a blood test for prostate cancer in Finland. Only about a third of those who were positive had cancer upon biopsy. That is why you only get tested when there are other reasons to believe you have prostate cancer. Otherwise, you risk further investigations that can be harmful, that can cause nerve damage, that can create unnecessary anxiety. When your doctor tests you for something, they will have worked out the likelihood of you having a certain health condition beforehand. Context matters. What about wearable technology? I have my smartwatch right here, and while I’m sceptical of how useful all this data is on my heart rate, stress levels and sleep, I don’t think it has harmed me. I think the appeal of those numbers is that they condense the terrible complexity of life into a simple, magical number. When I am on my exercise bike, it is the only moment in the day where I know exactly how I am doing. I know my heart rate. I know how many watts I am putting out. I have a totally honest account, whereas, right now, I don’t know how I am doing in this interview. I think you are doing a good job. That is good – yet I want an objective score out of 10! But to get to your point, I think there are two different ways to think about wearable technology. Although they can create an unhealthy relationship with data – maybe people chase their step count or develop an exercise dependency – for most people, they just give you a number. There is no evidence they will make you fitter. But I am a big fan of democratising health information. I like knowing about my body. I think it is similar to owning a set of bathroom scales. You probably know which way the dials should be trending. It gets sinister and dangerous, in my opinion, when these devices screen for illness. Many wearable technologies are approved [by the US Food and Drug Administration as] medical devices, but the medical industry puts them to very different use than the wellness industry. Wearing a glucose monitor if you have diabetes can save your life. Wearing a glucose monitor for “wellness” could actually harm you, because you then try to flatten or remove blood sugar spikes that are normal, physiological responses. It generates alarm about foods that aren’t harming you, leading you towards eating less fruit, fewer legumes, fewer whole grains, more cheese and meat, which makes your cardiovascular risk worse. I once bought two simultaneous subscriptions to the same personalised nutrition app. I wore two glucose monitors, sent two scoops of the exact same poo, drew blood from each arm on the same day. I sent in the same exact data, yet got completely different results on my blood sugar and microbiome and completely different advice about what I should eat. So you are getting nonsense back. If the wellness industry is full of nonsense, why do you think interest in wellness has exploded in recent years? I lay a lot of the blame at the feet of the medical industry. I do think the medical profession has many failings that have pushed people toward wellness. It is difficult for a lot of people to access healthcare. Even in places with universal healthcare, such as the UK, it is hard to get an appointment, and when you do, you only get so much time because there are not enough doctors. Part of it, too, is the medical industry lets certain groups of people down, particularly women and minority groups. So even if they can access healthcare, they have a difficult time getting the treatment they need. Look at menopause: consumers spend billions of dollars each year on menopause supplements. Do you know how much the US spends every year on menopause research? I want to guess $100 million, but that feels too small. We would dream of $100 million! Instead, it spends $57 million a year. We don’t even record how much we spend in the UK, because we basically spend nothing at all. So there is no money for this. Now, imagine going through menopause, which can be extremely difficult, and the scientific establishment just isn’t interested in that particular problem. It is no surprise, then, that you would turn to the wellness industry. Many people’s experience with healthcare is that it is disempowering and paternalistic, and I think people want to feel empowered. Doctors are also constrained in what they can offer. When you buy a supplement, there is an aura of possibility it will make you live forever. When you buy a drug, your doctor says: “There is a 20 per cent chance it will reduce your risk of heart attack in the next 10 years by 5 to 7 per cent. Also, here is an endless list of potential side effects.” It isn’t very exciting. What advice to you have for people wanting to improve their wellness? Or are we tough out of luck? Make use of healthcare professionals before you buy a single wellness product. Have you had your colonoscopy? Do you know your blood pressure? Are you eating your vegetables? These straightforward basics are what improves wellbeing. You should also think of wellness beyond health. It is a way of feeling good that should be grounded in community and family and friendships and personal growth. I am not anti-wellness. I just want to save people time and money and set them free to do what matters to them. Find something you love and pursue it with enthusiasm and passion. That is the best bit of wellness advice I have come across. Whatever it is – martial arts, knitting, dancing, pottery – maybe that is the wellness metric you want to aim for. And if biohacking is your passion, go for it. That is up to you. But if you are casting around wondering whether some blue zone, supplementary, special-treatment, stem-cell stuff is going to extend your life, I wouldn’t bother. I would disregard all of that.