Last week I talked about supplements and toad venom. This week let's talk about dietary supplements and safety.

When people hear a supplement is “natural” and “plant-based,” they assume it must be safe, especially when there is no warning on the label. However, many plants are toxic; comfrey, for example, has a comforting sound to it, but it can be toxic to the liver and kidneys and cause death. Remember that almost half the pharmaceutical drugs prescribed by physicians or purchased over-the-counter are derived from plants (aka botanicals). In fact, many of the drugs in US supplements are regulated as pharmaceuticals in other countries.

The unfortunate truth is that seemingly innocuous supplements can make you sick, and be life-threatening, because they can interact with other supplements or medications. For instance:

•     Immune system boosters, such as vitamin E, zinc, or echinacea, can interfere with drugs designed to suppress the immune system, such as corticosteroids, often prescribed for everything from asthma to brain tumors

•     High-dose vitamins, fish oil, garlic or garlic can combine with an anticoagulant drugs, such as warfarin which also inhibits blood coagulation, and increase the risk of abnormal bleeding during dental and surgical procedures

•    Calcium taken at the same time as some thyroid medications and antibiotics cause less of the thyroid medication to be absorbed into the bloodstream

•    High doses of Vitamin A can damage the liver.  

•    Vitamin D can damage the kidneys and cause calcium to be deposited in the soft tissues of the body.  

•     High doses of vitamin B6 can cause neurological damage.

You will find more at FDA website: http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm096386.htm#supplements

Also check out the National Institute of Health's supplement information:http://ods.od.nih.gov/

Yet despite questions of supplement quality, efficacy, and  safety, we take them anyway. A TOJ just has to wonder - why?

Probably because some supplements do work for some people. Reminding ourselves, again, that each body is unique, certain people may benefit from them in some objective, measurable way. In some cases, there have been certifiable results, e.g., fish oil for heart health. Surely not every person giving a testimonial is a liar.

Also, we cannot forget the placebo effect, a baffling, but real, phenomenon that has proven many times, even in evidence-based medical settings, to influence health outcomes. The power of suggestion has worked miracles. Maybe people who take a pill and say to themselves “Now I’m going to lose weight!” start eating less and exercising more because on some subconscious level the pill gives them strength and determination to break old habits.

That's what I do with glucosamine-chondroitin. I take a couple of them, lace on my running shoes, and think to myself, "I will run forever." Yep, lots of dietary supplements are really a hope and a prayer.

Magic Offerings

A TOJ is much more careful about what he puts in his mouth than what comes out of it. For that reason I was rummaging around the Internet for information about the safety and efficacy of dietary supplements when I found this great article by Stephanie Mencimer written in 2001. Referring to the  Dietary Supplement and Health Education Act (DSHEA) through which the supplement industry was ensured virtually no regulatory supervision, she wrote:

“Since DSHEA became law, substances as varied as paint stripper, bat shit, toad venom, and lamb placenta have all been imported from overseas, bottled up---often by people with no scientific or health backgrounds---and marketed as dietary supplements to unsuspecting American consumers. Many supplements have been tainted with salmonella, arsenic, lead, pesticides, unapproved foreign prescription drugs, as well as garden-variety carcinogens. And despite their New-Age health aura, a significant portion of these "natural supplements" are stimulants, depressants, and other mood-enhancers that some medical experts believe would be classified as drugs if they were synthetic. A surprising number of these products are addictive.”

Say what? Bat shit? Lead? A few more disturbing facts about dietary supplements:

• Supplements are considered food, not drugs, even if they have pharmacological properties
• Labels are not required to have warnings or contraindications
• Any supplement is considered safe unless its proven otherwise by large numbers of adverse events, e.g., hospitalizations, death, and birth defects
• Most ingredients are imported from countries with few regulations like China

 
Unfortunately, DSHEA is still the law of the land. Since 2001 when the Mencimer article appeared, the U.S. Food and Drug Administration has received a little more power over the supplement industry, but not much. In 2007 the FDA issued Current Good Manufacturing Practice (GMP) regulations to help the supplement industry do a better job. In a gesture of good faith, the Natural Products Association created a voluntary GMP certification for manufacturers. To date, only 70 companies out of over 2,500 have acquired certification; you can find a list of those who have here.

In fairness to the FDA, it has not been given the authority or funding to ride herd on the supplement industry as much as it does the medical drug industry. Yet don’t think that supplements cannot be equally dangerous. Remember ephedra? It took 10 years and countless deaths for the FDA to ban it.  Vitamin E, garlic, ginseng, and ginko biloba are blood thinners that can cause life threatening complications in surgical and dental procedures. Comfrey may be a sweet smelling herb, but it can be toxic to your liver and kill you.

The FDA has written some useful advice that everyone (including you) should read.

Be wary of supplements that are marketed as a cure or treatment for a disease. For one, it’s illegal. But more importantly, recent studies have shown many vitamins and concoctions don’t do what they claim. These false claims have a long legacy. As Mencimer recounted:

“Back in 1905, reporter Samuel Hopkins Adams wrote a famous series of stories in Colliers' magazine called "The Great American Fraud," which documented the deaths of hundreds of people from over-the-counter medicines that were peddled with promises to address "weak manhood," "lost vitality," or to give consumers "better blood." Patent medicines were widely available and promoted in the press with testimonials from people claiming to have achieved great results from these magic offerings.”

Does this sound familiar? Here we are in 2011. Today over half of American adults take a supplement, around $27 billions worth. The top sellers are multi-vitamins, sports nutrition powders, calcium, and weight loss formulas. If you’re one of the one half, then check out the quality and efficacy of what you  are putting in your body at Consumer Labs, an independent testing lab that assays whether the stuff has what is says and does what it claims.

Better yet, do it before you buy it and put it in your mouth. Are all supplements bad for you? No, but they're not necessarily good for you either.