(MONEY Magazine) – HYPED ADVERTISING. INACCURATE LABELS. Useless costly ingredients. And products sold long after they've lost their potency. We're not talking about food supplies peddled on some Third World black market. We're describing vitamin, mineral and herbal supplements that millions of trusting Americans shelled out an estimated $5 billion to consume last year.

A four-month Money investigation reveals that a staggering 35% of the billions Americans pay annually for vitamin, mineral and herbal supplements goes for products with no scientifically proven health value. What's more, many of the remaining dollars--34% in our shopping tour of health stores in 31 cities--go for pills and powders whose potency has expired by the time you buy them. Still more is spent on items diluted by additives that do little more than boost prices.

Those are among the major findings of an exclusive Money investigation that incorporated the latest medical studies, interviews with dozens of scientific researchers, physicians and consumer advocates, and the dispatches of 31 correspondents across the country who personally checked out 186 health shops and 310 other stores where vitamin and mineral supplements are sold. Our investigation also found that:

More than 90% of the products sold by health stores to the Money reporting team were of questionable medical value.

Many extra ingredients that push up supplement costs--such as exotic herbal substances that one consumer scientist calls attitude food for the '90s--have virtually no health value and may in fact harm you.

And contrary to today's pervasive vitamin hype, medical experts we consulted say that only four types of supplements, costing as little as 12 [cents] a day, have been scientifically proven to enhance your health.

Based on our study, here are the most important lessons for consumers:

You waste money following most health store recommendations. Posing as ordinary consumers, Money reporters visited 186 health stores in 31 cities and asked clerks for help. They said they had heard that vitamins and minerals could be beneficial but didn't know what to buy. The clerks sold the reporters an average of $26.13 of products per store, for a total cost of $4,859.46. Nearly all that money was wasted. A full $4,590.42 worth of the products either fell short of the health value requirements of our medical experts or did not carry an expiration date on the label--meaning there was no assurance the stuff was still effective. In the Los Angeles area alone, supplements pushed by salespeople at five out of six stores had no expiration dates listed.

You probably need only one mineral and three vitamin supplements. There may never be unanimous medical agreement about the links between supplements and good health. But there is solid scientific evidence that because they don't get all their essential vitamins and minerals from their diet, most Americans need four supplements a day--calcium, vitamin C, vitamin E and a multivitamin. "Taking any nutritional supplements beyond those four is unnecessary," says Dr. Gerald Keller, past president of the American Academy of Family Physicians. Yet in 1993, the last year for which full statistics have been released, Americans doled out about $1.5 billion on those unnecessary supplements--$900 million on extraneous vitamin and mineral products and $600 million on herbal items. That amounted to 35% of the total $4.3 billion expenditure on supplements for the year--and spending has increased substantially since then.

You don't have to spend more than 21 [cents] a day. By shopping wisely, you can consume the medically recommended dosages of calcium, multivitamins, vitamin C and vitamin E for 12 [cents] to 21 [cents] a day, compared with the 77 [cents] Money's shoppers spent following the health store advice. One savings tip: The best-selling brands of vitamin and mineral supplements are also manufactured under discount labels that sell for as much as 50% less. For example, Pharmavite, whose Nature Made supplements are the nation's top sellers, and Leiner, whose Your Life products are No. 2, also turn out similar vitamins and minerals that are sold cut rate as the store brands of Walgreens, Rite-Aid, Wal-Mart, Osco and Eckerd Drugs.

Avoid any supplements that boast about their "sustained release" of nutrients. "Sustained release sounds good," says Ralph Shangraw, professor of pharmaceutics at the University of Maryland. "But different vitamins are dissolved at different sites in the digestive tract, so if release is delayed too long, vitamins that must be absorbed high in the gastrointestinal tract may not be absorbed at all."

Don't pay a premium for supplements with herbal ingredients. "Even if herbal substances had a proven value, which they don't," says David Roll, a professor of medicinal chemistry at the University of Utah, "there's a real possibility that putting everything in but the kitchen sink may make the essential nutrients less bioavailable [able to be absorbed by the body]. That's because the herbal stuff may bind to minerals and make it difficult for your body to absorb them." At the very least, says Roll, you'll be throwing away the extra money you spend on the expensive stuff.

Our study showed that:

The more money you pay for supplements, the more you tend to waste.

The items that cost our health store shoppers most were herbal remedies (also known as botanicals), energy supplements and other exotic-sounding but scientifically unproven products. At the New Harvest Foods vitamin shop in Glendale, Mo., for example, our reporter bought the $83.73 worth of supplements and remedies that were suggested by the salesclerk. Among the most expensive was a $22.95 11-ounce jar of Royal Jelly, a substance produced by worker bees. The clerk touted it as an energy booster "that makes the queen bee queen." Royal Jelly is widely promoted as being able to increase longevity, promote healing and enhance sexual performance. Maybe this is so, but only if you're a bee. "Any value for Royal Jelly in human beings," says Roll, "is purely psychological."

Also, salespeople at St. Louis' New Dawn Natural Foods store barraged our correspondent with supplements that will do little for her beyond lightening her wallet by $52.67. Among them: Happy Camper, 15 capsules for $4.99 that will supposedly provide peace of mind and renew energy. Bruce Silverglade, of the consumer advocacy group Center for Science in the Public Interest, dismisses Happy Camper. "This stuff is nothing more than ginseng and a number of other herbs," says Silverglade. "It's expensive, and there's no scientific proof that it works." Indeed, there is little scientific backing to support the current craze for herbal supplements. Varro Tyler, professor of pharmacognosy (the study of natural drug products) at Purdue University, reports that in the U.S., fewer than a dozen of the roughly 600 botanicals on sale have been subjected to the controlled clinical trials that determine whether an herb is safe. And medical experts say that even those few have not yet passed enough rigid scientific tests to learn what health benefits, if any, they may have.

When retailers did recommend scientifically proven supplements, they nearly always pushed expensive ones. At the Arizona Health Foods store in Phoenix, for instance, the clerk singled out a vitamin and mineral supplement called More Than a Multiple Vitamin by Good 'n Natural. The cost: 64 [cents] a day for the dosage medical experts endorse. That is exactly 16 times higher than the 4 [cents] a day you would pay for a discount label multivitamin providing all the nutrients you could want from such a supplement.

Most of our women reporters say the clerks tried to sell them multivitamin supplements designed exclusively for females. Those gender-geared products can cost as much as 31 times more than regular discount house multivitamins. Yet a regular multivitamin and a calcium supplement costing a total of a mere 7 [cents] to 13 [cents] a day deliver all the extra amounts of the nutrients that women need more than men: folic acid and calcium. There's marketing hype aimed at men, as well. At Alfalfa's Market in Denver, our reporter was urged to buy New Moon Extract's New Chapter-Every Man, a multivitamin "the clerk told me contained all of the miracle items needed to change the life of a man my age." On close inspection, our reporter found that its main distinction was merely its exorbitant cost: $1.15 a day.

Why so many extravagant claims? Because no one is properly policing the vitamin supplement industry. "Vitamins fell into the crack between food and drugs, and since they weren't considered to be in either category, no federal standards were ever established for efficacy or truth in labeling," says Gale Bensussen, president of the world's largest vitamin manufacturer, Leiner Health Products. For example, a 1987 report by pharmaceutics professor Shangraw revealed that half of the more than 50 calcium supplement brands he tested at random did not disintegrate enough to allow the body to absorb the amount of calcium the label promised. "Think of the millions of dollars that were ripped off over the years from women who thought they were warding off osteoporosis [bone degeneration] with calcium supplements that were actually doing them little or no good," says Abbey Meyers, president of the nonprofit National Organization for Rare Disorders.

Five years ago, the Food and Drug Administration began proposing regulations to Congress that would place the nutritional supplements industry under the jurisdiction of the Nutrition Labeling and Education Act of 1990. The act mandates that no health claims are allowed on food labels or in advertising unless an FDA review has established "significant scientific agreement" for the claims. The supplement industry fought the FDA. In 1994, a bill introduced by Sen. Orrin Hatch (R-Utah) and backed with a $2.5 million lobbying effort by the industry sought to reduce FDA scrutiny. A compromise bill passed last fall affirmed the right of the FDA to require strict scientific proof of direct claims about disease prevention or cure. But the bill gives manufacturers license to claim that a vitamin or mineral has some general impact on the body. For example, FDA approval is not required if a vitamin A label says the supplement promotes good vision but would be necessary for a claim that it cures cataracts.

"This really loosens up how products can be marketed," says Silverglade of the Center for Science in the Public Interest. "It allows broad health claims that could be misleading to be placed on labels." He worries that the label of a supplement is now allowed to say that the product boosts your immune system, and also that the immune system is essential in fighting AIDS. This implies the product is helpful in fighting AIDS, he says, even though there is no widely accepted scientific support for that claim.

The new law also reversed some basic consumer protection. For example, previously if laboratory tests found that an ingredient in your vitamin supplement might cause liver damage, the FDA had the power to have it removed from store shelves until the question of its safety could be resolved. Under the new law, the FDA has to go to court and prove the item is unsafe, which could take as long as a year. Meanwhile, the product can continue to be sold, and all the FDA can do in the meantime is issue public health warnings. "And no one seems to pay much attention to them," says FDA spokesman Brad Stone.

The law does gives the FDA authority to establish good manufacturing practices standards, which the agency hopes will put an end to problems like those disclosed by Shangraw in his study of calcium supplements. But it may take another year or two before the particulars are in place. So for the moment, no government regulations stipulate even that the vitamins and minerals you buy must dissolve sufficiently for the body to absorb the amount promised on the label. However, Money's 20-city price guide beginning on page 84 can steer you to supplements that pass that test and comply with other strict scientific standards set by the U.S. Pharmacopeia (USP), a respected nonprofit group with headquarters in Rock ville, Md. Over the next three years, most brands that meet USP's requirements will carry the letters USP on their labels. If you do not see USP on a label, pass up the product, at least until you can call the manufacturer to learn whether it conforms. All supplements listed in our price guide meet USP standards, according to the companies.

You also should follow this advice about shopping for specific supplements:

MULTIVITAMINS

The U.S. Recommended Daily Allowance (USRDA) of vitamins and minerals--that is, the amount necessary to meet the known nutrient needs for a healthy person--is set by the FDA. You see these USRDA numbers on many food packages and supplement labels. The best way to get your vitamins and minerals is through diet, because fresh fruit and vegetables, for example, provide fiber and other nutrients that can't be fully replicated in supplements. Unfortunately, national nutrition surveys, such as those conducted by the U.S. Centers for Disease Control and Prevention, show that only about one in five adults consumes the minimum recommended amount of fruit and vegetables each day. Moreover, even when we try to eat healthier, we may unintentionally miss out on some nutrients as a result. "Part of the reason we're seeing an increase in zinc deficiencies is that people are moving away from red meat," says Gladys Block, a professor of the School of Public Health at the University of California at Berkeley. "Also, calcium intake has gone down as we try to lower fat intake by cutting out cheese."

"Taking a multivitamin supplement is a reasonable, inexpensive way to ensure that you're getting the minimum amounts of essential nutrients your body needs," says Jeffrey Blumberg, chief of the antioxidants research laboratory at Tufts University. Furthermore, a 1992 study of 96 people over age 65, financed by the Nutrition Research Foundation and Memorial University of New Foundland, showed that regular multivitamin users were sick with infection-related illnesses for only half the time than participants who did not take the pills.

Look for a multi that provides 100% of the USRDA for vitamins A, C, D, E and the B-complex group (B1, B2, B6 and B12) and also includes at least 11 different minerals. In addition, women of childbearing age should make sure the multi has 400 mcg (micrograms) of folic acid, which has been shown to help prevent spina bifida and other neural-tube birth defects. All the multivitamins in Money's table meet those requirements.

CALCIUM

The evidence supporting calcium's ability to prevent the painful bone deterioration, osteoporosis, is so overwhelming that it's one of only two disease-prevention claims that the FDA allows the supplement industry to make. (The other is for folic acid's ability to reduce birth defects.) The USRDA for calcium is 1,000 milligrams (mg), but the National Institutes of Health recommends that women over 50 and men over 65 take 1,500mg. Osteoporosis mostly affects older people; a man's bone mass decreases at a steady rate, while a woman's drops precipitously at menopause.

The latest national nutrition survey by the U.S. Centers for Disease Control and Prevention shows that the average American diet provides less than 750mg of calcium daily. Multivitamin supplements can't fill the gap because most contain only 200mg of calcium or less, so a separate supplement is needed to fight osteoporosis.

Calcium, which can be dissolved only in the stomach, is most effective when taken with food. It's wise to split your daily intake, consuming, say, 500mg with breakfast and 500mg with dinner. To ensure that the calcium supplement you bought will disintegrate in the stomach quickly enough to be effective, you can perform this simple home test: Drop the calcium tablet in vinegar (which simulates stomach acid) and stir it three or four times over a one-hour period. If the tablet is still intact after two hours, get another brand.

ANTIOXIDANTS

Over the past decade, an increasing number of scientific studies have indicated that people who consume several times the USRDAs of antioxidants--vitamins C, E and beta-carotene, which is a form of vitamin A--were less likely to contract cancer, heart disease and other illnesses associated with aging. Anti oxidants boosters say that they reduce cell damage caused by "free radicals," a destructive form of oxygen molecule that appears naturally in the body. Free-radical damage accumulates as people age and may trigger malignant cell growth as well as encourage the formation of oxidized LDL, the "bad" form of cholesterol that clogs arteries.

Epidemiologists Tim Byers and Geraldine Perry of the U.S. Centers for Disease Control and Prevention recently reviewed 116 antioxidants studies published since 1987. They concluded that antioxidants "could become an important component of an effective strategy for cancer control before the close of this century."

As you might guess, the supplement industry has transformed the good news into grandiose hype. For example, a General Nutrition Centers ad hails its anti oxidant pill as a veritable fountain of youth: "Help your body win the battle against time." But many scientists question whether the favorable studies were somehow skewed by outside factors, such as the subjects' dietary practices or lifestyles. Therefore the skeptics are calling for controlled clinical studies of people with similar behavior patterns. In such studies, the subjects are randomly divided into two groups; one gets nutritional supplements, the other placebos. After several years, any health differences between the groups can reasonably be attributed to whether or not they were taking supplements.

Several such clinical trials are under way, but significant results won't be in for years. Until then, the evidence for taking one of the three top-selling anti oxidant supplements--beta-carotene--will remain questionable. On the positive side, early results on a 300-patient subset of the U.S. Physicians' Health Study showed that those taking 50mg of beta-carotene every other day had 44% fewer heart attacks and other coronary disorders than the placebo group. In other studies, however, it's not clear what effect body weight or physical fitness had, as well as whether beta-carotene is the nutrient that improves health. Regina Ziegler of the National Cancer Institute's environmental epidemiology branch points out that while studies indicate that eating plenty of fruits and vegetables is associated with reduced cancer risk, beta-carotene is just one of several hundred fat-soluble antioxidants found in them.

However, while the beta-carotene debate continues, there is strong evidence supporting the benefits of two other top-selling antioxidant supplements: vitamins E and C. Vitamin E appears to reduce the risk of cardiovascular disease, in part because it prevents the formation of oxidized LDL. Two studies published in the New England Journal of Medicine in May 1993 are especially persuasive. The Nurses' Health Study, an epidemiological study of 87,245 nurses begun in 1976, found that women taking at least 100 IU (international units) of vitamin E per day for two or more years reduced their risk of heart disease by 43%. A similar study involving 39,910 male health professionals, conducted over four years by the Harvard School of Public Health's Eric Rimm, found that men taking at least 100 IU experienced 37% less coronary disease than nonusers. Such a dramatic reduction argues strongly for taking the supplement, especially since it is impossible to consume such high levels of vitamin E from food alone. "Based on those studies and others, there is good evidence adults should be getting 200 IU to 400 IU of vitamin E daily," says professor Roll. "If you tried to get that amount from food, you'd end up weighing 400 pounds. For example, you'd have to consume one cup of corn oil just to get 30 IU of vitamin E." (When Roll and other medical experts recommend taking a supplement daily, they acknowledge that missing a day here and there has not proved to be a problem.)

There is also substantial support that vitamin C supplements help prevent heart disease and cancer. The first National Health and Nutrition Examination Survey that was conducted by the U.S. Centers for Disease Control and Prevention followed 11,348 adults who were taking vitamin C for 10 years, ending in 1984. When their health was compared with the average for their age group, those with the highest intake of vitamin C had experienced 34% fewer deaths caused by cardiovascular problems.

Moreover, 33 of 46 recent medical studies tracking vitamin C intake indicated that the vitamin provided statistically significant protection against cancer. Among other benefits, high intake of vitamin C supplements reduced by twofold the risk of developing cancer of the esophagus, larynx and pancreas. There is also evidence of a protective effect from cancers of the stomach, breast and cervix. The effective daily doses of vitamin C seemed to be about 500mg. By contrast, the U.S. Centers for Disease Control's nutrition survey found that the public's median intake of vitamin C through diet is only 78mg a day.

If you shop wisely for vitamin E (400 IU) and vitamin C (500mg), you can spend as little as 3 [cents] to 5 [cents] a day for both. Don't pay higher prices for supplements promoted as complete antioxidant formulas. They come with many costly nutrients thrown in that you don't need.

Two other important tips: When buying vitamin E, choose the synthetic form. Natural E costs twice as much, and though studies indicate natural E is absorbed slightly better by the body, the difference is inconsequential. And don't pay extra for vitamin C promoted as being superior because it's derived from rose hips, an ingredient extracted from the rose plant. "Rose hips are an extremely expensive source of vitamin C and have not been shown to be superior," says pharmaceutics professor Shangraw.

Finally, this word about vitamins. They can't help you anywhere near as much as you can help yourself. Physicians' Health Study director Charles Hennekens, for example, notes that "the dividend from quitting smoking and otherwise avoiding a harmful lifestyle is much greater than the payoff from taking antioxidants or any other supplement." In short, no vitamin pill can substitute for healthy living. As Tufts researcher Jeffrey Blumberg puts it: "Like seat belts, supplements can provide you with some protection against injury, but they won't protect you against the equivalent of reckless driving: a low-fiber, high-fat diet and no exercise."

Reporter associate: Amanda Walmac