Is Algaecal a Marine Mineral Miracle or Just Another Overhyped Health Product?

7 minute read
Originally posted here: https://mcgill.ca/oss/article/health-you-asked/algaecal-marine-mineral-miracle-or-just-another-overhyped-health-product-2

Every supplement makes flashy claims, but the ones made by AlgaeCal, that it is “the only calcium supplement that increases bone density” is particularly bold. You see, while every other calcium supplement currently on the market can, at best, decrease the rate of loss of bone density, AlgaeCal claims to be able to fully tip the scales in the other direction and make your bones denser with time. So, are the makers of AlgaeCal lying, or is it truly a miracle marine mineral? Does it represent a breakthrough in the way that we treat osteoporosis? Let’s look at the science.

Why do I care how dense my bones are?

Put simply, because bones that are less dense break more easily, and no one likes broken bones.

As we live our day-to-day lives our bones receive micro-damage. To combat this, our bones are in a constant state of remodelling. So constant in fact that up to 10% of our bones may be in the remodelling process at any one time. This remodelling has two main parts: bone resorption, and bone formation. Most of the time these two processes exist in equilibrium, but as we age this equilibrium can shift (for a wide variety of very complicated reasons). The result is osteoporosis. It affects roughly 10% of Canadians aged 40 or older and is characterized by weak and brittle bones that break in situations healthy bones would not, like when bending over to pick something up.

We can put a number on this loss of bone strength by looking at bone mineral (a calcium-containing compound that makes up 70% of the mass of a human bone called carbonated hydroxyapatite) since it is responsible for most of a bone’s strength. The bone mineral density (BMD) is a good predictor of fracture risks and can be easily and painlessly measured using a DEXA test.

As aside: What is a DEXA test?
DEXA stands for dual-energy X-ray absorptiometry, a non-invasive procedure that involves lying on a table for several minutes while two X-ray beams are aimed at your hip, spine, wrist or other bone. As for how this allows doctors to measure your BMD, I’ll let Osteoporosis Canada explain: “Think of the light shining through the curtains of your home on a sunny day. The amount of light that reaches your eye depends on the thickness of the curtains. If your curtains are very thick, very little sunlight passes through them. If, however, you replace them with a thinner fabric, the light coming through to you will increase substantially. Similarly, a bone densitometer uses a detector to measure the transmission of small amounts of X-rays (light) through your bones. The amount of light that passes through the bone is measured, thus providing a radiologist with a picture that indicates how dense (thick or thin) your bones are.”

How well do the existing calcium supplements work?

AlgaeCal costs more than 100 times as much as normal calcium supplements, so it must work much, much better right? Well, to answer that we first have to look at how well traditional calcium supplements work.

A 2007 meta-analysis published in The Lancet found, looked at both studies using fractures or BMD as their endpoint, and found that calcium supplementation was associated with a 12% risk reduction in all fracture types, and a 0.54% reduction in the rate of BMD loss in the hip and a 1.19% in the spine.

Basically, calcium supplements can help mitigate the decrease in BMD and increase in fracture risk that come with osteoporosis.

An aside: Why do we sometimes use fractures and sometimes use bone mineral density as our outcome?
The main negative outcome of osteoporosis is bone fractures. So, when we’re testing treatments for osteoporosis, we would ideally use fractures as our endpoint. Basically, that means that we would test if patients receiving a particular treatment suffer fewer fractures to see if that treatment works. This, however, can be difficult to do. If researchers run studies on osteoporosis treatments only lasting a few years, they may get artificially skewed numbers, as patients could experience no fractures during the study, but suffer one days after it ends, or they could experience two fractures during the study period but never another. Hypothetically, researchers could monitor osteoporotic patients from the time they’re diagnosed with osteoporosis to the time of their death, but the logistics of funding and operating an over-30-year-long study would be monumental. So, our options are to either run studies over only a few years using fractures as an endpoint but with a large number of participants to help account for the inconsistencies or to use bone mineral density as a surrogate clinical endpoint.

While some studies have found that calcium supplementation is not effective unless given with vitamin D, the Lancet meta-analysis found no statistical difference between the risk reductions offered by calcium alone versus calcium + vitamin D. Vitamin D only affected the fracture risk if the patient was deficient in it, and a similar effect was seen with calcium. Essentially, if you’re vitamin D or calcium deficient, it could be affecting your body’s ability to create new bones, but if you’re not, taking a vitamin D supplement likely won’t help you avoid broken bones, and taking calcium supplements will only help a bit.

How is AlgaeCal different from traditional calcium supplements?

What is it about AlgaeCal that allows it to do what other calcium supplements cannot? Well, what is AlgaeCal?

As you may have gathered from the name, AlgaeCal is made from algae. Specifically, a red algae found in the waters near Brazil, South Africa and New South Wales in Australia. The AlgaeCal website explains that the balls of algae are harvested by hand, sun-dried and then milled into a powder. It states that it is “pure whole food,” even though it is very literally not whole but ground up and that AlgaeCal contains “Nutrients. Not Chemicals.” I hate to be the one to tell them, but calcium, the selling point of their supplement, is so much of a chemical that it’s even on the periodic table of the elements!

The website states that AlgaeCal Plus naturally contains “all 13 essential bone supporting minerals: calcium, magnesium, boron, copper, manganese, silicon, nickel, selenium, strontium, phosphorus, potassium, vanadium, and zinc”, as well as vitamins D3 and K2. Unfortunately, they only provide values for six of these minerals, making it impossible to know if the others are present in useful amounts.

Even for the minerals we know the amounts of, the research supporting their effects on BMD is a bit weak. This 2008 study found no relation between boron intake and BMD in the femur or lower spine, and this 2000 studyfound that low vitamin K2 intake was not associated with low BMD.

So, if these minerals don’t matter, is the calcium in AlgaeCal somehow different than traditional calcium supplements?

Well, it claims to contain “pre-digested” or “plant-digested” calcium. Unsure what this meant, even having studied science for many years, I reached out to the company and asked. Unfortunately, their answer didn’t really explain much: “In regards to pre-digested, the algae itself absorbs all 13 bone-building minerals and pre-digests them for you.” I guess what they mean by pre-digested is just one of the great mysteries of the universe, like dark matter and why it’s impossible to eat only one potato chip.

Anyways, whatever pre-digested means, all that really matters is the bioavailability of the calcium or the amount that is absorbed through your digestive tract and into your bloodstream.

Calcium in conventional calcium supplements (or “rock-based” calcium, as AlgaeCal calls it) can be in a variety of salts, which, according to a 2000 review have bioavailabilities ranging from 23-37%. So, this is the number to beat for AlgaeCal.

Too bad we have no idea what the bioavailability of AlgaeCal actually is! While a clinical trial to answer that question was started in 2009 and finished in 2010, no data from it was ever published. Perhaps because it didn’t show the results that AlgaeCal wanted it to.

Nonetheless, the AlgaeCal website claims that there are 4 studies that support their product’s effectiveness. So, let’s take a look at those.

The studies of AlgaeCal

The first one published looked at AlgaeCal’s effects on human bone cells. The researchers treated human osteoblast cells with either AlgaeCal, calcium carbonate or calcium citrate, and found that AlgaeCal-treated cells showed statistically better function than the cells treated with the other calcium compounds. But there are two problems with this study. First, results in Petri dishes rarely translate directly to humans. Second, this study was funded, at least in part, by AlgaeCal. A conflict of interest that throws all of these results into question.

The next two studies (12), both done in 2011, were thankfully done in humans. They compared several “bone-health plans” (see image below) implemented in 176 participants and found that any of the plans were associated with increases in BMD. Not just that they slowed losses but that they increased bone mineral density!

Unfortunately, a few aspects of the designs of these studies prevent us from trusting their results. They weren’t blinded in any fashion, which means the results could be extremely biased, and they were not placebo-controlled. Oh, and also the lead scientist, Dr. Gilbert Kaats, is the CEO of Integrative Health Technologies inc., a company that has invested in AlgaeCal, and funded one of the studies! That’s a conflict of interest if I’ve ever seen one.

The last study on their site, from 2016, is also headed by Dr. Kaats, and funded via a grant provided by AlgaeCal themselves. Like the others, it wasn’t placebo-controlled or blinded in any fashion and, like the others, it showed increases of BMD over a 7-year period.

If we could trust these results, that is to say, if these results were replicated in a double-blind, placebo-controlled study that wasn’t funded by AlgaeCal or led by someone with a conflict of interest, it would be incredible. If we truly could increase the BMD of those with osteoporosis, not just slow their losses, it would literally revolutionize how doctors treat these patients. But when something seems too good to be true, it usually is.

It’s certainly true that new drugs or treatments are sometimes discovered that revolutionize medicine. A quick look at ganciclovir or penicillin proves that. But it doesn’t happen often, and before we start considering AlgaeCal revolutionary, we need an independently performed study.

So, while we don’t know if AlgaeCal is a pseudoscientific product, it sure does market itself like one. Ever since I first googled this product, I have been inundated with ads for AlgaeCal on every platform from Twitter to Buzzfeed. Now, aggressive marketing doesn’t necessarily mean a product isn’t evidence-based. However, when I’ve previously looked into the science behind products that forcefully target me with ads (like BioSilAllerpet or Skinny Magic) the evidence has not been in their favour.

As of right now, it’s hard to say whether AlgaeCal works or not. All we can really say is that there’s no good evidence that it does. Also, it’s expensive. At $2.17 CAD per day, you would save quite a bit of money by instead buying a traditional calcium supplement and throw in a vitamin D supplement too, for $0.14 per day.

Is Hyaluronic Acid All Hype?

3 minute read
Originally posted here: https://mcgill.ca/oss/article/health-quackery/hyaluronic-acid-all-hype

A quick search of Amazon for hyaluronic acid turns up thousands of products, from liquid serums to pills to creams that make a variety of claims. Balms and serums seem to focus on hyaluronic acid’s ability to ease skin redness and reduce wrinkles while oral supplements focus on the benefits of hyaluronic acid on the joints. Some products, like this powder, make claims about hyaluronic acid’s benefits to both the skin and joints.

How can one substance have so many effects? And is there any truth to the ‘organic liquid facelift’ or ‘joint solution’ declarations?

Within the body, hyaluronic acid plays an important, albeit diverse, role. It is a major component of epithelial tissue, and seems to play a role in cell division and movement. It is also a chief component of synovial fluid- the fluid found inside a synovial joint (like a human’s hips or wrists)- and acts as a lubricating agent. Hyaluronic acid is also found in joint cartilage, where it coats all the cells, and it even plays a role in the body’s innate immune system (high hyaluronic acid levels can be used as a marker for prostate and breast cancers). The average person has ~15 g of hyaluronic acid in their body, and about 1/3 of it is degraded each day.

In short, hyaluronic acid does a lot of things, from skin repair to joint lubrication, so it makes sense that promoters hype it as a possible treatment for a wide variety of health problems ranging from osteoarthritis to sun burns. But what does the science say about its efficacy?

Studies have shown intra-articular injections (injections into the joint) of hyaluronic acid to be just as effective, and sometimes more effective, at managing pain than NSAIDS or placebos, often with fewer side effects, for patients with osteoarthritis. Likewise, studies looking at artificial tears containing hyaluronic acid, used to treat chronic dry eyes, have found it to be a safe and effective option. Same story with dry skin. The thing that begs investigation however, is the oral administration of hyaluronic acid.

There have been a few studies on oral treatments of hyaluronic acid, and they all seem to have quite positive results. This study found that daily supplementation with oral hyaluronic acid enhanced several markers of quality of life in adults with osteoarthritis of the knee, and this study concluded that oral intake of high purity hyaluronic acid is effective in the treatment of American patients of knee osteoarthritis. Some studies, like this one partnered oral hyaluronic acid supplements with exercise and also had positive results.

These results seem promising, and I’d be right on board the hype train with everyone else, if I hadn’t spent some time reading the methods sections of these studies. Each study used a daily amount of hyaluronic acid ranging from 60-200 mg. Most supplements recommend hyaluronic in the 100-200 mg range, but Novisyn, perhaps one of the best known supplements, contains only 17 mg of hyaluronic acid in its once a day packets. 

There is good reason to believe that orally administered hyaluronic acid is absorbed in the digestive tract and that it does migrate to the relevant connective tissues. There is also evidence that it can have a biological effect without even being absorbed. These functions however, depend on there being enough hyaluronic acid molecules present to interact with the relevant receptors, and in a 17 mg dose, this likely just isn’t the case.

So by all means, ask your doctor about hyaluronic acid for your osteoarthritis or chronic dry eyes, but make sure to read the package before you buy the pills. As Dr Joe always says, it’s all about the dose!

Gaba Supplements: Glorious, Gimmicky or Just Garbage?

7 minutes read
Image created by Ada McVean
Originally posted here: https://mcgill.ca/oss/article/health/gaba-supplements-glorious-gimmicky-or-just-garbage

Take-home message:
– gamma-Aminobutyric acid (GABA) is a major neurotransmitter that regulates much of our brain function. It was previously thought that ingested GABA could not cross the blood-brain barrier, but new research suggests that it may be able to.
– Drugs that mimic the action of GABA are numerous, work in a variety of ways, and can have effects ranging from treating epilepsy to causing it.
– GABA supplements have shown some promise in early, small-scale studies, but a lot more research is needed to know if they truly help.

Lately, it seems that GABA supplements are being hawked on the corner of every pharmacy aisle and health food shelf. Marketed to promote relaxation, mental focus and sleep, GABA is even being sold by David’s Tea in the form of GABA guava tea. I found it while trying to buy some matcha powder. I don’t even like guava, never mind guava with a side of inflated claims.

While promotions by influencers like Olivia Culpoand Sarah Couture are pretty standard for any trendy supplement, (regardless of efficacy) the attention GABA has been given by known quacks like Dr. Oz,Joseph Mercola orMike Adams has left me wondering about the science behind, and evidence for, these supplements.

Let’s start with the basics: what is GABA?

gamma-Aminobutyric acid (also written as γ-aminobutyric acid) is a neurotransmitter, specifically the major inhibitory one in all mammal’s central nervous systems (CNS). That means that it’s a chemical that binds to nerve cell receptors and hinders their ability to receive, create or send messages to other nerve cells (neurons).

Functionally, GABA is incredibly important. A lack of GABA leaves your central nervous system with too many neuronal signals and causes conditions like epilepsyseizures or mood disorders. Meanwhile, too much GABA means not enough brain activity and can lead to hypersomnia or daytime sleepiness.

You can learn more about GABA in this lovely video, and more about neurotransmitters in general in this one, although I’ve said all you’ll need to know for this article.

GABAergic drugs

As the chief inhibitory neurotransmitter in the CNS, GABA and its receptors have been major targets for drug development. Drugs that activate GABA receptors (called agonists) or increase the receptors’ sensitivity to GABA (positive allosteric modulators) work to reduce the neuronal signals in the user’s brain, similar to what happens when you sleep. Logically, they include many common sedatives like barbital or Quaaludes, tranquillizers like ValiumAtivanor Xanax and the most commonly used sedative, alcohol.

GABA reuptake inhibitors like Deramciclane have similar effects, as they help to keep GABA in the vicinity of the receptors for longer.

On the flip side, substances that inhibit the activity of GABA (called antagonists) increase brain activity. That only sounds like a good thing. The results are less Scarlett Johansson in Lucy, more uncontrollable seizures and death.

GABA antagonists, like gabazine or bicuculline are only useful when studying seizures or to counteract overdoses of sedatives and tranquillizers. Some GABA antagonists are particularly scary poisons, causing death by disrupting the CNS’s control of basic body functions like breathing.

The class of drugs we’re most interested in, however, are GABA analogues. These molecules are structurally similar to GABA, though they have different targets of action. GABA analogues include some big names you’ve probably heard of: Lyrica and gabapentin.

While both Lyrica and gabapentin are prescribed to stop seizures, treat neuropathic pain, and anxiety disorders, gabapentin is additionally used for the prevention of migraines.

Gabapentin has been a constant in my life for a few years now, as my mother was prescribed it for diabetic neuropathic pain just a few years after my partner was prescribed it for near constant migraines. I’ve personally seen GABA to be quite effective in its on-label uses, as the evidence shows it to be, but it was recently at the heart of one of the largest court settlements in US history.

The manufacturers of gabapentin were found to have been marketing it extensively for off-label uses like the treatment of bipolar disorder, restless leg syndrome, hot flashes and stopping smoking. While off-label prescribing is not uncommon, and usually fairly safe, there is no evidence that gabapentin is effective for the bipolar disorder it was being prescribed to treat or some of the other conditions for which it’s being prescribed.

Presently gabapentin is again making headlines as its use as a recreational drug skyrockets. Many opioid users are misusing gabapentin to extend opioid highs or bypass drugs that block opioids effects, but its status as a non-controlled substance makes it difficult for law enforcement to control its unsanctioned use.

GABA and the Blood-Brain Barrier

GABA drugs are certainly useful, but why do we need all these GABA-receptor-activating or GABA-like molecules in the first place? Why not just give patients GABA?

We have a highly selective membrane that keeps our blood and cerebrospinal fluid (or brain juice, if you will) separate: the blood-brain barrier (BBB). Some molecules, like water, pass through it easily, other things, like bacteria don’t. This membrane also contains special channels to diffuse important molecules one way or the other, like glucose.

It’s a really important border, as drugs that cannot cross into the brain, or do so poorly, have much less of an effect than ones that do. For example, morphine can’t cross the BBB very well, but it’s close relative heroin can! Upon entry to the brain, heroin is converted into morphine, which is why heroin is so much more potent than morphine.

A 1958 study was the first to look at GABA’s relationship with the blood-brain barrier, and it found a lack of one: GABA could not cross the barrier. Later studies in ‘58‘71, and ‘88 confirmed the barrier’s impermeability to GABA. The evidence seems all but clear until you throw a few more studies into the mix. Studies done in ‘80‘81‘82 and ‘02 found that GABA did cross the blood-brain barrier, just in minuscule amounts.

Why the disagreement? Well, a few things. Some studies used a molecule just like GABA in lieu of GABA, assuming the 1 extra OH group featured on 3-hydroxybutyric acid wouldn’t make a difference, but it may have. Since many studies don’t report the type of GABA used, it’s hard to compare results. Some studies administered their GABA by injecting it straight into animal’s body cavities, others by injecting it into veins.

Most importantly, the BBB permeability of GABA has never been studied in humans!

What we do know is that human’s BBB contains transporters for GABA, implying that GABA can enter/exit the brain through these channels. In mice it was found that GABA was removed from the brain 17 times faster than it entered.

This could explain the conflicting study results. It may not be that GABA cannot enter the brain, but just that it’s removed from it very rapidly.

GABA as a Supplement

Even if it cannot cross the BBB however, GABA could still be affecting your brain.

The enteric nervous system (ENS) is the network of neurons that control your gastrointestinal system. The ENS contains many GABA receptors, and GABA itself, and is connected to the brain through the vagal nerve. It’s been proposed that ingested GABA is able to affect the body even without crossing the BBB through its interactions with the ENS.

We don’t know at this point how GABA is affecting the brain, but we have good evidence that it is. Several studies have shown reductions in markers of stress in patients given dietary GABA.

On their own the success stories from the consumers who buy GABA supplements are meaningless but taken along with the research findings, they may just show that there is something to these supplements.

We’ll need a lot more research to know for sure if GABA supplements are helpful or not. That being said, they are expensive (like most supplements) and if you’re not anxious, experiencing insomnia or very stressed out they’re probably not worth it. There don’t appear to be many side effects or drug interactions, but until more research is done I’d tread carefully.

I did ask my partner, who took gabapentin (a GABA analogue) for years if he ever experienced any focusing of his mind or relaxation as the GABA supplements claim. He said a definitive no.

Want a cheaper option for relaxation? Tea. You can even try some GABA tea, a strain of green tea specially fermented to accumulate GABA. Maybe I’ll pick some up… just not that guava flavoured stuff.

Skinny Magic is a Fat Scam

Originally posted here: https://mcgill.ca/oss/article/health-and-nutrition-quackery/skinny-magic-fat-scam

Skinny Magic, Skinny Magic Zero Appetite and Skinny Magic Cleanse are herbal weight loss remedies created and sold by The Herb Shop, a subsidiary of Jade Enterprises based out of Florida. Jade Enterprises seems to have been unable to pick just one industry to become involved in, and opted instead to just dabble in all of them- they own several herbal supplement companies (including IAmHealthy.net), a photography and Photoshop company, and a window film company that specializes in ‘Toilet Tattoos’.

All three products claim to do as their name suggests, with that being helping you lose weight with natural herbs and superfoods in the case of their ‘skinny’ products. The company’s main claim is that their pills will energize you, allowing you to increase your activity levels while reducing your appetite so you reduce your caloric intakes. How the ingredients in their product do this, however, is up to interpretation.

Each pill contains chromium, niacin and vitamin B6 and B12, calcium and magnesium. Sadly, the amounts of calcium and magnesium are so small that you’re likely getting more from just your daily breakfast. The pills also contain 487.6 mg of what they refer to as their ‘Proprietary Blend’- a mixture of several ‘superfoods’ like stinging nettle, apple cider vinegar, barley grass, bladderwrack and other algae. Even if there were reason to believe any of these ingredients could perform the weight loss miracles the pills claim, it’s impossible to evaluate their efficacy, as the company refuses to give the make-up of its ‘Proprietary Blend’. For all we know, the blend is 99% apple cider vinegar, and the same experience could be had drinking what’s already in your kitchen cupboard.

The recommended use of Skinny Magic is 1-3 capsules per day, 30 minutes before each meal, but not within 7 hours of bedtime, as they may impair sleep. This likely has something to do with the 100 mg of caffeine in every pill (more than a cup of coffee). At 3 pills per day, any more than 1 cup of coffee in addition to these pills would put you over the Health Canada recommended daily maximum dose of 400 mg of caffeine- and how many of us only have 1 cup of coffee a day? This caffeine content likely explains the numerous customers experiencing nervousness, the shakes, and insomnia.

Beyond duping customers into buying these pills based on their weight loss claims, The Herb Shop seems to have another trick up their sleeves to take the money out of desperate pockets. A full bottle of 60 Skinny Magic pills (a month’s supply) will run you $59.95. At almost $1/pill plus shipping, you can imagine the creators had a hard time selling their magic to the public. To combat the trepidation, they began offering trial packs- 10 pills (a week’s supply) for $12.50 plus shipping. While this price is increased per pill, it’s cheap enough to coax wary customers to try the product. But, as numerous customers report, the formula of the trial pills and the normal pills greatly differs. This difference is made possible by the company’s use of an unspecific ‘Proprietary Blend’, which, as I’ve mentioned, allows them to do as they will with the quantities of each ingredient in the blend. Even if the pills worked, there is no way to guarantee from batch to batch or size to size that you’re receiving the same pills you found effective last month.

These pills boast big claims, but as their website is quick to point out, none of them have been evaluated by the FDA or Health Canada. Their own website points out that these pills are not meant to diagnose or treat any diseases, and that you should contact a licensed health practitioner, whom I just could not see prescribing these ‘magic’ pills.

BioSil: Can it Really Help Thicken Your Hair and Nails?

Originally published here: https://mcgill.ca/oss/article/health-general-science/can-biosil-really-help-thicken-my-hair-and-nails

The ads for BioSil look and sound like every other supplement ad. There are bold claims like “promotes unbreakable nails” (I’m pretty sure that’s impossible); references to science like “molecular biologists have pinpointed the key structural protein…” and “your own DNA fingerprint”; and a blond celebrity (Christie Brinkley) smiling while talking about how this product, in particular, has changed her life.

The BioSil website features the familiar refrain “This statement has not been evaluated by the Food and Drug Administration” after every statement about their product, as well as snazzy scientific-looking pictorial representations of what it can do for you.

BioSil is manufactured by Natural Factors. Their site features images of sprawling fields and a cross-section of a grassy patch complete with worms. Everything about it inspires thoughts of nature, because natural is always better, right?

Too bad their site also says “You should not use the information on this site for diagnosis or treatment of any health problem or for prescription of any medication or other treatment.” I would definitely call a supplement for “Rejuvenating your hair, skin, and nails” a treatment, but what do I know?

BioSil’s advertisements, bottles and website make three main claims:

  1. Thickens and strengthens hair
  2. Improves skin elasticity and reduces wrinkles
  3. Strengthens nails

The active ingredient in BioSil is choline-stabilized orthosilicic acid (ch-OSA). Orthosilicic acid is just a silicon atom surrounded by four hydroxide (OH) units, but it is unstable on its own. Enter choline. Choline is an essential nutrient for humans that most of us consume more than enough of every day (it’s found in everything from cauliflower to tofu to chicken to almonds). In BioSil, choline serves to stabilize the orthosilicic acid.

BioSil’s website constantly references clinical trial results, so I read the two trials in question. It’s important to note that we can’t take these studies’ conclusions at face value. Not all studies are created equal. There are a plethora of issues that can hide in a study’s design that could call its conclusions into question. We need to evaluate the design and procedures of a study to know whether we can trust its results. That’s not always an easy task, so let me help.

The first study involved 48 middle-aged, white, healthy women with fine hair (as determined by the study’s hairdresser). 24 of the women were given a placebo, while 24 were given 10 mg of ch-OSA orally for 9 months, during which they did not heat or colour-treat their hair. The 45 women who finished the study had the diameter and tensile strength of their hair measured at the beginning and end of the treatment.

As for the results, well, they’re pretty confusing. I mean look at this:

“the elastic gradient decreased in both groups, but the change was significantly smaller in the ch-OSA group (-4.52%, P = 0.027) compared to the placebo group (-11.9%).”

What does P = 0.027 mean? Let me try to explain.

When a scientist writing a study says that something is significant, it is not the same as when I yell at my TV that the colour of the Monster’s hair on The Masked Singer is significant. Significance in science actually refers to statistical significance, which is measured with something called a p-value.

It’s a controversial way to measure significance but has been something of a standard for a long time (though that is slowly changing). You can click below to read about how p-values work and why they are so confusing, but to evaluate this product all you need to know is that if something is statistically significant, we can say that it is meaningfully different from something else.

For example, we could take a hair sample from someone in the ch-OSA group at the beginning and end of the 9-month period and compare them. A statistically significant result would mean that they are significantly different, i.e. that the thickness of the hair changed in those 9 months.

We could also compare the hair of someone using ch-OSA to the hair of someone using a placebo at the end of the 9 months. A statistically significant result here would mean that whatever happened to the hair with ch-OSA did not also happen with placebo.

Almost every experiment has two hypotheses. Yeah, two. The null hypothesis is the status quo, the prediction that nothing will change. By finding a significant p-value you disprove the null hypothesis. In the Biosil study’s case the null hypothesis is that there was no difference between the effects of the placebo and the ch-OSA. The other hypothesis is the alternate hypothesis, the prediction for the effect your treatment will have. By disproving the null hypothesis, you can conclude that the alternate hypothesis may be confirmed. In this study’s case it’s that the ch-OSA supplement improved hair strength and cross-section more than the placebo

So how do we decide which hypothesis fits with our study results best?

The p-value!

Often times the seemingly magical target to match or surpass is a p-value of 0.05.

That tells us that there is only a 5% chance of obtaining the data we did, or data more extreme than ours if the null hypothesis is true.

In our case a p-value of 0.05 would mean that there was only a 5% chance of getting our data, or data showing even more difference between the placebo and ch-OSA if the placebo and ch-OSA really did have no difference in their effects.

Why 0.05? Because that is what scientists have decided. They could have decided something else, and many others do use a different value. But 0.05 remains the usual p-value threshold of significance.

Looking at the study results we can see that the decrease seen in the elastic gradient of hair was significantly smaller in the ch-OSA group than in the placebo group. This would imply that the ch-OSA helped the hair stay stretchy.

But, we can also look at the yield extension of hair, and see that it was significantly increased for both the placebo group and the ch-OSA group. This would imply that it was not the ch-OSA that caused the improvement in yield extension.

Looking at hair diameter (the literal hair thickness) we can see that the hair of those who took the placebo did not significantly increase, whereas the hair of those who took ch-OSA did. So that is a good mark in ch-OSA’s book, right?

Well, it is not as simple as proving significance. Something of concern in these results is the considerable amount of overlap between the placebo’s effects and the ch-OSA’s effects.

Take a look at the graphs below. I’ve shown the range of results for the ch-OSA group in yellow, and the range of results for the placebo group in blue. Where there is green means that they overlap. 

The majority of each coloured section is green.

This means that there was quite a noteworthy amount of people in the ch-OSA group who experienced the same effects as the placebo group, and vice versa.

Do you really want to pay $25.99 plus tax per month for the chance to be in that little yellow bit?

There is another thing we need to remember when looking at these results: statistical significance does not always equal practical significance.

Those who took the ch-OSA saw a statistically significant increase in their hair diameter, sure, but did they notice it in the mirror, shower or at the hairdressers? Did their hair feel thicker to them? It is possible that the result was statistically significant but that, if asked, participants would say their hair felt no thicker to them, meaning that it was not practically significant.

Do you really want to pay $25.99 plus tax per month for results you can’t even see?

We can evaluate the practical significance of a result through something called the effect size. This measures the magnitude of a phenomenon and would give us an idea not just whether hair thickness improved but also by how much. Sadly, this study does not report an effect size (although judging by the percent increases in diameter of hair, I would guess that it is likely quite small).

So, can ch-OSA make your hair thicker? Maybe. But also, maybe not. And probably not by that much.

As for the other study the product cites, well, I’ll skip explaining the analysis of this one and cut to the chase.

The second study showed that ch-OSA actually decreased skin hydration, although it did very slightly improve skin roughness, nail brittleness and hair brittleness. The problem again is one of effect size. Looking at nail brittleness, participants had the brittleness of their nails ranked from 0 (not brittle) to 3 (severely brittle). With ch-OSA treatment their brittle scores did decrease, but by very little.

So, can ch-OSA help your skin be smoother, your nails be stronger, or your hair be thicker? If you are a middle-aged, healthy, white woman who does not treat her hair, maybe. A teensy bit. But if you are anyone else, we have no evidence to suggest so.