What is a Wellness Grift?
Basically a grifter is a con artist and what they do is grifting. The wellness industry is littered with them. People who exploit aspects of wellness for personal gain.
Lots of people have got in on this act. Some well meaning, some foolish, some out and out grifters, The wellness industry is not regulated, and nor is the supplement industry and it is an open door to people who do not have your best interests at heart, they have their own at heart.
In this article I will deconstruct the claims made by one supplement manufacturer. It feels to me like a wellness grift designed to separate people from their hard earned cash and I will explain why their claims are, at best, wildly exaggerated, in order to sell you their product. In their defence, they offer a free handbook on bladder care which gives some really useful information and recommends their pads, their supplements and squeezing the pelvic floor as treatment for pelvic floor issues
Here is the link to their supplement https://wearejude.com/ecommerce/products/bladder-care-supplements
The company made it onto my Instagram feed via sponsored advertising. They claim that their tablets, containing Squash in the form of Pumpkin Seed extract and Soy Germ extract can cure a number of types bladder issues
The tablet allegedly sorts out urgency, overactive bladder and night time urination and stress incontinence.
Most people from here to well, practically the edge of the known universe, will tell you that squeezing, (contract if you prefer), your pelvic floor will solve pelvic floor dysfunction. I am one of the minority who is anti pelvic floor squeezing as treatment for the pelvic floor, despite the near hegemony of the advice and the NHS app for pelvic floor strength being called “Squeezy”. I do approve completely of teaching people how to correctly identify and contract the pelvic floor and people doing a few “squeezes” but “squeezing” is not complete, or even partial solution. There is more to solving pelvic floor problems than that. For some people they are totally the wrong thing to be doing
I have written about this in a different blog, outlining the debate around Kegels. Kegels is another name for the exercise of squeezing/contracting/lifting the pelvic floor and you can read it here.
Not a Wellness Grift
Some wellness practice is pleasant, life affirming, enjoyable, relaxing, stimulating, interesting. I have regular massages. I value them and they help my muscles to be less tight and that helps me. Plus I really enjoy it.
I’m not going to try and consider whether massage is wellness or essential although that is a valid question.
My experience of Reflexology is that it is pleasant but sadly, in my case, utterly pointless in terms of addressing my chronic health issues. If you are wondering why I thought it might help, well that is because it was told that it would. It was harmless and relaxing but not useful.
Naïve claims of success
Many people have said they’d cure me of chronic issues. None of them did and now, older and wiser, I don’t listen to extravagant claims. Basically if anyone says they can cure your chronic health problem, at the very least be careful and approach with caution. Helping is another thing entirely. Claiming to help is fine, curing is not but it is a fine line and of course one that is open to exploitation. Vague symptoms on a continuum, varying day to day perhaps, are a good entry point for a wellness grift. You take the treatment and aren’t sure if it helps, “but it might be helping! “. So you carry on.
Some Wellness practice is a rip off and whilst not physically dangerous, it is upsetting when doomed to failure and possibly expensive.
Today I am talking about one particular wellness grift: supplements. In this case to cure your bladder and pelvic floor problems.
A quick note on the pelvic floor and bladder issues
There are a number of different and also common pelvic floor and bladder problems. This is important stuff to know. The problems are quite varied and need different treatment approaches and the fact that a supplement claims to treat all of them is a big red flag and puts me into cynical mode
Your classic “sneeze pee”. For that read, jumping pee, coughing pee, trampoline pee, falling off a kerb pee, getting up from a low chair pee. Basically the pelvic floor cannot react properly to a change in intra abdominal pressure and you leak urine
Urgency and Urge incontinence
Urgency is the sudden need to urinate, possibly despite having been to the toilet recently, and despite only voiding a small volume of urine. Urge incontinence is leakage of urine one the way to the toilet. If you don’t leak you still have urgency but not urge incontinence. Some of this is behavioural. Sometimes it is caused by having an overactive bladder.
This is an issue of the bladder muscle and as such, not a pelvic floor issue. It can affect anyone but is a known side effect of neurodegenerative diseases such as Multiple Sclerosis and Parkinson’s.
It is generally treated with medication. Ones that have undergone a randomised control trial (RCT).
This is the problem of getting up at night to urinate. It is also caused by an overactive bladder and also treated with medication.
What does the NHS say?
The NHS outlines the basics in their article here
The NHS recommends lifestyle change, pelvic floor exercises and bladder training as non surgical treatments for incontinence. Not supplements!
This is a bit of a side note, but, the NHS suggests three lifestyle changes: weight loss, drinking more or less, avoiding caffeine
Reading this led to another outburst of fury chez nous. I really could not be more angry about this fat shaming. It was just so simple wasn’t it? Just a little dose of anti fat bias, snuck in so the thin people can feel better about themselves and read yet another back handed criticism of fat people. Shame on you NHS. And if you doubt me, ask yourself this? What might the risk factors for pelvic floor dysfunction be? Do only fat people have dysfunction? Are thin people all trampolining away happily with their dry knickers?
I am not denying that extra weight will be a risk factor for pelvic floor dysfunction, but there are loads and loads of causes and quite a few solutions but the NHS didn’t bother to mention them. If I had to suggest lifestyle factors, I’d say:
Move more, sit less, take regular exercise (you can pick and mix from that list); learn to breathe more effectively; be wary of too much squeezing; treat constipation if you have any.
End note for my deviant views
Irony of ironies, belly sucking to look thinner is a cause of pelvic floor dysfunction and breathing dysfunction.
I kid you not.
I have talked about anti fat bias in the Pilates industry in an previous blog post which you can read here
I am not writing about it here, but Pelvic Organ prolapse and chronic pelvic pain influence and are influenced by the health of the pelvic floor
These things, particularly if you include organ prolapse or chronic pain are complex, different and multi factorial. They are not cured overnight and definitely not all cured by one pill
This short GIF is really persuasive isn’t it, but think about it. Do you really think that oral soy germ extract is somehow going to selectively strengthen your pelvic floor without you don’t anything else or without strengthening any other muscle? When did you last strengthen a muscle without doing anything apart from taking a pill, let alone a muscle as mercurial and hard to reach as the pelvic floor? Or perhaps Soy Germ extract strengthens all muscles? If so why aren’t we taking it for all of our muscles? Are all the gym bros drinking soya germ based protein shakes post workout?
Relaxing an overactive bladder? I am less knowledgeable here, but this I do know: if you have concerns about an overactive bladder than it needs investigation with your GP and possibly then via a Urology team. It may then be treated with real drugs that have been through a randomised control trial. That is, with a statistically significant group of people with half assigned a dummy pill.
This screen shot shows what their daily tablet can achieve. It is equally persuasive and seductive, sounding to me like the siren calls of a wellness grift
The manufacturer is claiming to cure different things with radically different causes and involving different muscles.
The two powerful ingredients must be really amazing if they can strengthen the bladder simply by strengthening the pelvic muscles. (their words). They are not the same muscles. That would be like improving the cardiac muscle by doing bicep curls.
In many ways this is a behavioural and neurological issue. We have to learn to sense bladder fullness and train the bladder to accept normal bladder volumes. Is the same pill that magically strengthens the pelvic floor and make the bladder stronger by some kind of pill based strength osmosis, also going to enable us to feel things differently as well?
As I have said, is this pill really going to address learnt behaviours such as “just in case pee-ing” or “latchkey incontinence”? The latter is a classic case or urgency. You are ok until you get to your front door then you desperately want to pee. Another trigger might be the sound of running water. So the tablet is going to magically teach us to slowly address those behaviours which are learnt, is it?
Presumably this is related to the number of times you have to get up to pee in the night. People with over active bladder often find they pee in the night because the bladder naturally relaxes at night and they can then void urine more easily. If you have an overactive bladder that needs to be diagnosed and treated. If you are very stressed and holding tension in the body in general, then relaxing at night might cause you to pee more at night. This also applies to constipation. Holding tension in the body, especially the lower body can cause constipation. This is a behaviour/emotional thing and needs a gentle, relaxation based approach.
This is your classic stress incontinence and as I said, a pill to magically strengthen the pelvic floor? This is without even considering that some people’s leaks are due to their pelvic floor being too tight and weak (hypertonic), not too floppy and weak (hypotonic). 2 different muscle issues. Does the tablet sort both?
Don’t tell me: it improved the sex life of 67.3% of respondents. I made that up, but, with these extravagant claims maybe if you take this pill you can wash the pots 50% quicker, gain faster promotion at work and be more successful on Tinder. Go on manufacturers…….. . I dare you to claim to deliver superior orgasms. I mean why not? The pelvic floor is intimately involved with orgasm.
What does the evidence tell us?
My “evidence” is that rationally and logically a pill won’t cure those things. If it attempted to cure one thing, that would be more reasonable, but all of them? I do appreciate that this is not evidence. It is a call to arms saying “be careful here. All is not what it seems. Be wary of parting with your money”. Could we just hedge our bets and eat more Pumpkin seeds and soya beans?
The manufacturers claim they have evidence in the form of a clinical trial.
Let’s look at their evidence then.
Like so many “clinical trials” it does not stand up to scrutiny. The clinical trial given on the website is three mini trials containing a total of 130 people. That is approximately 40 people per test. One of the tests was with elderly men and none of these groups is a statistically significant size. That is, the group is not big enough to infer that the results will apply to the population as a whole. All tests were looking at the active ingredient of the supplement, not the supplement itself. None of it varied the amount of tablets, or how often you took them or for how long.
We do not know if the people recruited to the studies are standardised, in so far as, did they have similar presentations and similar issues? Had these people being carefully correlating their pee data prior to the trial or are we relying on what they remembered? In other words, how certain are we about the before and after data?
I note that that the website touts the fact that the supplements were co created with real women. However, they were only tested on approximately 80 women. The website does not say whether they were real or not.
My cynicism may rob me or indeed you, of the opportunity to benefit from the placebo effect. That is, feeling better or actually being better on the basis of the belief that the treatment/tablet/procedure is going to help.
This is a concern. However it doesn’t outweigh the reasons for calling this out as a potential wellness grift. Plus we can all chose to eat the active ingredients in the form of real food and gain the placebo effect from that.
I think it is more important to be clear. A tablet, especially one that has not been rigorously tested, will not cure a range of bladder and pelvic floor issues. It claims a quick fix and for most of us there isn’t one.
Bladder issues, and pelvic floor dysfunction need to be slowly and gradually treated with a multi factorial approach that whilst bespoke for each person, basically involves a mixture of the same sort of things.
I worry that people who take the tablets and find they don’t work will just have a bigger sense of failure and feel more broken because they weren’t cured. They weren’t cured because they were taking a cleverly marketed fantasy, not because they did anything wrong,
Don’t just take my word for it
The team behind the Zoe podcast recently had a short podcast talking about supplements for menopause and basically said that there was little or no evidence for their success but did refer to the power of menopause orientated marketing. You can listen to it here. The Zoe people are the specialists in personalised blood glucose monitoring and using that to change when and how you eat to reduce insulin resistance, heart disease and diabetes
For those of you who are contemplating reading Tim Spector’s latest book, chapter 6 is almost entirely devoted the supplement industry and the utter dearth of evidence to prove anything works. The book is called Food for Life: the new science of eating well. Tim Spector is Mr Gut Microbiome himself and was on the “Know your Sh*t” TV programme earlier this year.
We all have to make up our minds about the tsunami of advertising that washes over us on a daily basis, especially if you are on social media. On social media, adverts are targeted at you too, which makes it even more vital that we are alert to the possibility of extravagant claims and miraculous sounding cures. Generally if somethings sounds too good to be true then it is. Whilst I have been very critical over this supplement, I am not at all saying that pelvic floor dysfunction cannot be treated. The severity of it can be reduced with care, time and the right approach