This is the accompanying blog from Dr Rachie Reports, aired in the Skeptic Zone (ep. 9), December 19, 2008.

Today’s segment concerns the use of alternative medicine where conventional medicine was desperately needed. What makes this case even more distressing, is it involves the mistreatment and terrible suffering of a defenceless child by her brain damaged father.

This story dates back to September 2006, but only came to court in Australia this week. It details the fate of an 11 year old girl, who was admitted to hospital 2 weeks after contracting a serious heart infection, which manifested as a body temperature of 42?C, hallucinations, weakness and difficulty walking. The girl, who was described by the examining doctor as “sick as the sickest person I’ve ever seen in 35 years” underwent an emergency heart bypass and valve replacement, spent some time in a coma due to bleeding on the brain and remained in hospital for an entire year. She now has brain damage, uses a wheelchair (according to doctors she will likely never walk unaided again) and has reduced vision.

So how do we explain the rapid descent into illness of a young, previously healthy 11 year old girl? According to the court proceedings, the girl’s father reportedly had a “distrust of conventional medicine” and instead of seeking assistance from real doctors, he had been feeding the child a glyconutrient dietary supplement (manufactured and developed by Mannatech Inc.) in an effort to cure his daughter. According to a report tendered by a psychologist, the father’s belief in Mannatech Inc. supplements bordered on “obsessive” and cited that he had an “exaggerated view of his own knowledge and ability” about health treatments. Further, the court was told when his daughter presented in hospital her mouth was peeling, black and clogged from the administration of extremely high doses of the Mannatech Inc. supplement. Even more tragically, the father himself suffered from impaired judgement since he had received a brain injury several years earlier.

But what about this gluconutrient supplement and who are Mannatech?

Mannatech Inc. make a range of “wellness” products, including skin care, growth essentials, performance nutrition and weight loss products, but their signature product, a glyocoprotein dietary supplement is Ambrotose® complex. According to their website, it has been called the “missing link” in human nutrition “..allowing your cells to send and translate messages to each other enabling them to communicate clearly and operate efficiently” and “..help support your body’s immune system”. All marketing jargon designed to make it sound like the next miracle cure. But let’s look at the science of this stuff. What is actually in it?

Let’s focus on 2 of the components in Ambrotose® complex capsules, starting with Aloe barbadensis inner leaf gel powder which constitutes 78% of the tablet.

Aloe vera gel (AVG) from the leaves of Aloe barbadensis has been used over the centuries in folk medicine as a therapeutic agent. In 2006, Esua et al.(1), isolated the many components of AVG to determine which parts were responsible for these therapeutic effects. They reported the processing and conservation of AVG is critical to the stability of the active ingredients, since poor storage results in the breakdown of the potent compounds to malic acid, glucose and simple oligosaccharides; and “…therefore no reasonable biological activity can be anticipated from such a gel or products derived from it.” Another component, larch bark arabinogalactan isn’t digested at all by humans, rather the bacteria in your gut like to break it down, producing noxious gas in the process which translates to smelly flatulence for you. Fun!

“There are authentic, scientific studies that have looked at people drinking these kinds of materials, and it doesn’t really do anything except increase flatulence”, Glycobiologist, Dr Hudson Freeze.

Unlike pharmaceutical medicines, strict regulations are not in place to determine the exact composition of alternative medicine products in Australia. So, unless we were to take a tablet and do the analysis ourselves there is no way of knowing exactly how much, or how conserved the active ingredients remain in these pills.

But then we have come to expect this from alternative medicine products. What makes this case different lies in the history of Mannatech itself.

Earlier this year, they settled a USD11.25 million class-action suit which stated that the company allowed false claims about its supplements, and failed to control its sales agents. As part of the settlement, Mannatech admitted no wrongdoing. In 2007, the Texas attorney general charged them with unlawful, misleading sales practices, including making exaggerated claims about the therapeutic benefits of their dietary supplements and nutritional products as a method to increase sales. Documents filed in Travis County district court reveal Mannatech’s scheme to exploit families including those challenged by cancer, Down’s syndrome, cystic fibrosis and other serious illnesses. You can find them cited on various scamwatch websites and they even have a scathing Wikipedia page which details an investigation by the American ABC investigative journalism programme 20/20 reorting how Mannatech allegedly teaches sales recruits how to target Mannatech products to patients with specific illnesses in a manner that purportedly does not violate U.S. federal law*.

“Energy like you’ve never had before and wellness you can count on!” from the Mannatech website

Even more telling is their attempt to hijack Nobel Prize winning science in an effort to lend legitimacy to their supplements and in the process, getting it wrong! In 1999, the Nobel prize for Physiology or Medicine was awarded to Dr Gunter Blobel for his work with glycoproteins concerning “…the discovery that proteins have intrinsic signals that govern their transport and localization in the cell”. Someone at Mannatech Inc. got a little mixed up and changed the prize to the Nobel Peace Prize, the year to 1994 and the topic to “received for his discovery glycoproteins have with the body’s ability to fix itself”.

Thankfully the scientists involved did not take this lying down and issued Mannatech with a cease and desist notice. And on September 13, 2007, two respected glycobiologists authored a scathing critique of Mannatech which was published online for Glycobiology, and then subsequently withdrawn due to complaints from the company (it has since been published in Glycobiology, vol. 18 no. 9 pp. 652–657, 2008). This is when the preverbial began to hit the fan. On November 2, 2007 another critical analysis of Mannatech’s tactics was published in the highly respected peer reviewed journal Science, detailing the company’s attempts to infiltrate the scientific community including the story of a retired professor and Mannatech consultant who modified the 2006 edition of a respected science text book Harper’s Illustrated Biochemistry, to suggest the benefits of “glyconutrient supplements”.

Click here to download the pdf of the Glycobiology editorial which started all the fuss
Click here to download the Science article as a pdf

This is not to detract from the tragedy of this sad event. In court on Tuesday, the girl’s father pleaded guilty to one count of grievous bodily harm and was sentenced to 3 years jail but will be released on parole after 6 months, whilst the mother was sentenced to 12 months jail for child cruelty but was immediately released on bail. A most terrible thing to happen to a young family.

But the obvious question(s) remains; how can a company continue to sell dubious (at least according to sources I have seen) supplements on the internet? The victims in this case are a brain damaged, wheel chair bound 11 year old and a (no doubt) heart broken, brain injured father. Meanwhile, Dr Robert A. Sinnott, Chief Scientific Officer/Senior VP of Mannatech Inc. quietly collects his USD311,539 annual wage (with 23,400 bonus).

“It’s none of our business as glycobiologists if nutraceutical companies want to sell bark extract. When they begin to tie it to our discipline, that is the problem,” says Ronald Schnaar of Johns Hopkins University in Baltimore, Maryland, editor-in-chief of Glycobiology.

I’ll leave the final word with Mannatech themselves.

References: (1) Macniell F. Esua and Johann-Wilhelm Rauwald. Novel bioactive maloyl glucans from Aloe vera gel: isolation, structure elucidation and in vitro bioassays. Carbohydrate Research, 341; (2006):355–364.

*Mannatech was established by Sam Caster, coinciding with United States Congress’ passage of the Dietary Supplement Health and Education Act of 1994, which made profitable, marketing of a wider spectrum of dietary supplements a possibility. He resigned as Chairman of the Board of Directors in August 2007.

Footnote: For some fun (and just a little bit scary) correspondence from Mannatech believers TYPING IN THE CLASSIC ANGRY UPPER CASE, a statement from Manatech’s lawyers admitting that their products do nothing; “..that you immediately remove from your website any statement or reference which (i) states, suggests or implies that Mannatech nutritional products prevent, treat or cure disease” and our own Peter “Ratbag” Bowditch being called a “homo” for daring to criticise their products, visit Ratbags.

Acknowledgements: thank you to Michael Howard for the tip off, and to Dr Martin for scientific advice and discussion.

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