We Buy Vitamins So Eagerly. Is It Science, or Is It Fear?

"Vitamin pills cost a little more than gin or the fortune cookies at a Chinese restaurant, but they are far more popular than either — probably because they come in small bottles that look scientific."

We tend to feel that our bodies are declining every minute, and that without outside help, vitality and health are hard to hold on to. For the same reason, when vitamins were first isolated in the early 20th century, people felt a sudden grip on life and turned unusually optimistic. Back then, vitamins were mainly for people with severe nutritional deficiencies. That era is long gone.

Today the consensus is that taking supplements is like buying health insurance: you can't be sure it helps, but at least it does no harm, and it leaves you less panicked.

Supplement makers worked this out early. In the 1940s, Miles Laboratories, a marketing-savvy American company, stopped making the grand claims about vitamin efficacy that other manufacturers did. What it aimed at instead was "the latent psychological panic of well-nourished Americans (middle-class consumers) about nutritional deficiencies they cannot see." Rima Apple, who holds a doctorate in the history of medicine from the University of Wisconsin and teaches consumer science, retells this story in The Health Deception: An Alternative History of Vitamins (《健康的骗局：维生素的另类历史》). Another official survey found:

"Women are more likely than men to use vitamin products, and the more education a person has, the more likely they are to use them; professionals, white-collar workers and salespeople are more likely to become vitamin users than manual laborers."

Chen Li, 35, works at a design institute. For her daily "supplements" she keeps a palm-sized transparent pill box — the most popular kind right now, divided into little compartments packed with pills of every color. Before dinner, Chen Li takes them out in a strict order and swallows them. "These have to be taken before meals, they're antioxidants, I've kept this up for years." She seems to be in good spirits, though that may owe more to the strict control she keeps over her daily routine than to the pills. People like her, who feel a strong sense of responsibility for managing their own health, are what consulting and research firms call "in-charge" consumers.

"In-charge" consumers blur the real effect of supplements. Starting with vitamins, the making and marketing of supplements really has leaned on scientific evidence — but look closely and that evidence is usually vague and contradictory.

The murkiness of the science, though, hasn't dimmed anyone's enthusiasm. According to a survey by the Qianzhan Industry Research Institute, China's supplement industry entered a phase of fast growth in 2013, with industry sales revenue climbing from 113 billion yuan to 157.9 billion yuan, and passing 190 billion yuan in 2014. Between 2016 and 2021, sales are projected to grow from 260 billion yuan to 400 billion yuan.

Nor has academic controversy slowed the churn of new products. Supplement brands have moved on from early players like Amway, By-Health and Yangshengtang to foreign names that have caught on in the past couple of years, such as Blackmores and GNC. Foreign supplements come in more varieties and split needs more finely: in the vitamin category alone, GNC's website lists 186 different vitamin products, while By-Health has only 20. In Mintel's latest survey report, nearly 60% of urban Chinese consumers said imported supplements are better. More than 70% have already gotten into the habit of buying supplements from overseas.

Given that this is a science-based business to begin with, that result is no surprise. Late last year China's China Food and Drug Administration seized 31 kinds of counterfeit health foods, suspected of illegally containing added drug ingredients. Supplement regulation abroad looks stricter by comparison. In the United States, consumers even complain that the Food and Drug Administration does too much. This "gatekeeper" twice proposed rules to restrict vitamin manufacturing and marketing, in the 1960s and the 1970s. By the 1990s, when the agency again set out to give consumers the truth, it met "a force opposing the Food and Drug Administration that was just as powerful."

Women still make up the bulk of the people buying these imported supplements. In 2015 the cross-border shopping platform Xiaohongshu ran a ranking of overseas purchases voted on by 17.83 million people. The top three supplements were an anti-glycation pill, a grape-seed capsule and an evening primrose capsule, with the highest vote count reaching 530,000. Anti-glycation pills and grape-seed capsules are believed to improve the skin and fight aging; evening primrose is thought to regulate women's periods and hormones.

Daisy, who graduated nearly two years ago, is a typical urban female consumer. She works at a consulting firm in Lujiazui, Shanghai, and when she found she was working overtime so often that she couldn't keep her diet balanced, she decided to treat the symptom directly and bought evening primrose and chlorophyll.

These products first caught on in Japan. Japanese manufacturers, for instance, spent heavily on advertising at home to push a "young barley grass" product. Aimed at "city people who eat at irregular hours," the ads claimed young barley grass could "detoxify the gut, relieve constipation and correct an acidic constitution." The ads were so persuasive that they won over the shopping guides too. "Celebrities drink it, TV stations report on it, so of course the Chinese-speaking shopping guides in Japan are happy to recommend this kind of product [to Chinese tourists]," said Zhang Dachuan, overseas business manager for the Japan market at Mihui, a company that deals only in Japanese supplements.

Shopping guides are the supplement industry's "product reps" closest to the consumer. Their authority is doubtful, but their sway over a purchase is not small. When these tourists get home, they recommend the products to relatives and friends, and a new product quickly builds a name in China. Companies like Mihui have been the beneficiaries of this new wave of consumption. Products containing young barley grass sell better than anything else. Each month Mihui supplies 30,000 boxes of young barley grass to other platforms and sells another 20,000 on its own — which works out to 600,000 boxes a year for this one product.

Supplement buyers also get help making the smartest decision they can in a short time, from information platforms with solid reputations. Japan's @cosme Best Cosmetics Awards ranking is one of the most closely watched sources of beauty information; a Weibo post about the first-half-2015 @cosme ranking was reposted more than 13,000 times. Because collagen keeps showing up on the list, when a collagen product went on sale at 20% off in early March on the cross-border shopping site Xiaohongshu, "we sold more than ten thousand bottles in that one day's promotion," said Niu Xiaoqian, who handles public relations at Xiaohongshu.

Chen Yi, 24, is another fan of Japanese supplements. She thinks things made in Japan suit Chinese people better. She has taken collagen since 2013, and has used products from Shiseido, Fancl and Benefique.

The argument over whether collagen really slows aging has never stopped. Germany's Center for Human Cell Research has shown that changes in collagen's quantity, proportion and distribution are a direct factor in skin aging, while some nutrition specialists hold that eating collagen does not directly increase the body's own collagen synthesis, though it does have some nutritional value for the body, skin, joints and bones included. Still, "there is no evidence that its nutritional value exceeds the protein in ordinary foods like eggs and soybeans."

Chen Yi recommends collagen anyway. She thinks her skin is slowly getting better. "It works. It's like exercise — you can't see it now, but in a few years, when I stand next to people my age, there'll definitely be a difference."

An ambiguous answer that rests on personal feeling seems to be the best supplement users can offer. So can vitamin C treat or prevent a cold, or at least ease the symptoms? Feng Ying, a physician in the nutrition department at Huadong Hospital, said when asked: "I feel myself that loading up on vitamin C when a cold is coming on does something, but it isn't directly recommended in clinical practice." The same sort of answer comes from Linus Pauling, winner of both the Nobel Peace Prize and the Nobel Prize in Chemistry, who promoted high-dose vitamin C as a cold treatment. In the popular books on the subject, however, there is nothing beyond Pauling's own experience — no solid experimental grounds showing that the treatment really has science behind it.

People still want to believe Pauling, not only because he looks authoritative but because he delivered his message more warmly than most doctors do. On things that are merely nice to have, people decide both carefully and carelessly. In 2014, Luo Cai and her husband traveled to Australia, where others in their tour group were in the habit of taking supplements. "They told me the best brands in Australia were Swisse and Blackmores, so I bought some to try."

Now e-commerce platforms can simply sit back and collect; they no longer have to educate the consumer. nyso has long supplied the Japanese supplements sold on Vipshop, Jumei and Ymatou. Having seen plainly how well supplements sell, it was no longer content to be the middleman: last November nyso launched its own e-commerce site to sell Japanese supplements straight to customers. According to nyso's management, the site has gathered 50,000 users in four months, the average order has held at 300 yuan, and repeat purchases of the products taken as a course have been steady too.

Zhongtu Shijie has supplied Jumei since December 2014; its main products come from Australia. Asked about Swisse and Blackmores, co-founder Zhang Bin sounded conflicted. "Honestly we don't much like those two brands. They're too hot — the Australian traders are competing with each other over them, and often they can't even meet local demand, so the risk of running out of stock is too high." Blackmores has not formally entered the Chinese market, but thanks to China's cross-border import pilot program opened in the second half of 2014 (covering direct online purchase imports and bonded-warehouse imports), the company's fiscal 2015 sales jumped 36% from the year before to AU$471 million, with full-year net profit up 67%. Guangzhou-based Biostime bought an 83% stake in Swisse last August for HK$7.676 billion.

When Zhang Bin picks supplements for himself, though, he doesn't think the Swisse and Blackmores products he sells fit him best. Because he often has to drink when he goes out, and sometimes gets allergic reactions, a colleague recommended a liver pill that claims to be "mainly herbal extracts." "All natural ingredients, no side effects," Zhang Bin said. No side effects mattered to him a great deal; he took it for a year without worrying, and at his next checkup his liver had improved. He admits that while he was taking the liver pills he also genuinely cleaned up his habits and drank less than before.

Luo Jie's experience was not as good.

Luo Jie likes scrolling Weibo, where she often saw posts saying enzyme supplements detoxify the body, improve the skin and help you lose weight. Not long ago Luo Jie went to Japan, and her guide recommended enzymes too, saying almost exactly what the Weibo posts said: good for women's hormones and for the skin. Luo Jie decided to try it, and spent 1,500 yuan on a product called First Enzyme. When we first interviewed her, three weeks ago, she said the enzyme had cured her constipation and improved her skin. Three weeks later, in a second interview, she gave a completely different answer, one that landed like a bucket of cold water: "I feel like I got taken for a ride. It really doesn't do anything. I noticed that when I just sleep well for a few days, my skin is fine too."

We have no way to judge whether the enzyme did anything, and there's no telling — ask Luo Jie again at another time and she might change her answer once more. But her experience is at least a sobering one.

An article in The Atlantic analyzing why people believe so fervently in vitamins points out that it is because people are afraid of vague things. The body's health, and death, are both vague and unpredictable, and people like to have a grip on things. Take one supplement pill a day and you feel today is better than yesterday.

All three psychologists interviewed called this the "placebo effect." Take two groups of people and tell both that they are taking a drug that will act on their bodies, but in fact give it to only one group and give the other an inert substance. The result: both groups believed the drug had worked on them. One of the psychologists said that maybe what makes us feel better is the act of swallowing a supplement pill, not the supplement.

This psychological explanation is so stale that even Miles Laboratories, which invented the "one-a-day" marketing pitch in the first place, went further. What mattered, in its view, was not what happened after the consumer swallowed the pill, but finding solid scientific grounds (however imperfect they might be) to convince the consumer that what they were about to buy really was "a drug that will act on your body" — with no side effects, and at a relatively low cost in time and money.

Among pregnant women, the group most devoted to supplements, you will never find a waverer like Luo Jie. They are among the most loyal buyers of supplements from overseas.

Which is why Meiruibao, a company that arranges trips to the United States to give birth, has also started selling supplements for mothers and babies. This is its fourth year in Chengdu, and monthly supplement sales have grown from 30,000 yuan at the start to 250,000-300,000 yuan now. About 200 pregnant women a month go to the US to deliver through the company; beyond them, another fixed group of 5,000 people regularly buys the American supplements it brings in as a purchasing agent.

Meiruibao reckons it has done little marketing itself, and that users recommending the products to each other is the main reason sales are rising. That fits another theory psychologists point to: put an individual in a group, under outside influence, and the group's power grows exponentially. If one person would buy one bottle of vitamins, three people together will buy nine — reinforcing each other, they can push a whole product category into fashion fast.

This is exactly what doctors worry about most.

On the matter of supplementing nutrition, the answer doctors offer is unusually fussy. Feng Ying, director of the nutrition department at Huadong Hospital, says everyone's nutritional needs differ: even if two people take the same supplement, their metabolisms differ, so they absorb it differently. Each person has to supplement according to need, and too much becomes an overdose. "I can guarantee the 99%, but I can't guarantee the 1%. Whether to supplement still takes a specialist's advice — work out whether your diet already contains these foods, and if it doesn't, what the obvious signs would be, and check yourself against them. But even an assessment only reflects your current level, and your current summer level can't stand in for winter," Feng Ying said.

The curious thing is that the people buying vitamins and other supplements today tend to be the highly educated, who get their scientific knowledge from books and research reports. So even when someone like Feng Ying says this, they shrug it off.

Is it really the fear of getting old or getting sick? Largely, probably yes. But don't forget how much technology and business have contributed to this wave of consumption — they have, after all, packed belief and ingredients into one small pill. And taking one a day, how much of a deal is that?

Cover image source: celiac