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Health
Dietary supplements may be less than healthy
TALK ABOUT A PARADOX. People who would never smoke tobacco, drink sugar-loaded colas or eat a Big Mac probably don't think twice about mixing and matching the vast variety of supplements available at drugstores, health food outlets or through the Internet.
You've heard the spiel: Catching a cold? Take echinacea. Feeling depressed? Try St. John's wort. Memory a little shaky? Get going on the gingko. At best, the right supplement in the right amount can be helpful. At worst, supplements may pose serious health risks.
Polls say about half the population takes at least one supplement a day-everything from garden-variety multivitamins to exotically named herbs, enzymes, amino acids and botanicals. These are "natural" products, the thinking goes, so they're not dangerous. And if a little is good, a lot might be better.
According to a national Harris Poll in 2002, nearly two-thirds of consumers think supplements must be approved by a government agency, the products are required to carry warning labels, and safety claims are backed up by solid scientific research.
Wrong on all counts.
The federal Food & Drug Administration is not required to test or approve any of the 30,000 supplements -a $19 billion industry last year- that the agency conservatively estimates are sold in today's marketplace. For a supplement to be taken off the market, the FDA must prove it is unsafe-a long process, as witnessed by last year's ban of ephedra, a stimulant often found in weight-loss supplements that was investigated for nearly a decade. It's the only dietary supplement ever yanked by the FDA. (The FDA announced in November it will seek a more active role in monitoring supplements than currently allowed by law. The agency says it wants to take steps to assess product safety, ensure quality and evaluate labeling on supplements. Sounds good, but don't expect any action soon.)
In comparison with prescription drugs, which are scrutinized by the FDA for sound science and efficacy, there's a dearth of reliable research about the effects of supplements. That's because a natural product cannot be patented, so there's precious little profit incentive for major pharmaceutical houses to produce them. In general, interactions among supplements and most prescription drugs aren't known, nor is the strength and purity of the substances used in supplements' preparation.
All of which concerns Dr. Mimi Guarneri, a cardiologist and medical director of Scripps Center for Integrative Medicine, which opened in 1999 and offers conventional medicine along with what's known as "evidence-based complementary approaches." "More than 60 percent of patients don't tell their doctor they take supplements," she says, adding that even physicians aren't always informed about the potential side effects. "For most of us, medical school didn't cover that."
DO SUPPLEMENTS WORK, and are they safe? It depends.
Herbs are an especially attractive category of supplements to consumers because they are natural products, says Isabel Burk, a New York-based credentialed prevention professional and director of the Health Network.
"Most consumers are unaware that herbs have to be grown under certain conditions, and such factors as time and day of harvest, transportation to market and storage conditions must be taken into account in determining their efficacy," she recently told a medical convention in San Diego.
"Different parts of an herb have different chemical profiles, and most consumers don't know which part of a plant has been used in a supplement's preparation." She cites echinacea as an example of an herb whose root, stem and flower each have different uses.
Dr. Robert Bonakdar, director of pain management at the Scripps center, sees patients who may be taking as many as 30 supplements a day, often based solely on marketing pitches from supplement suppliers, the Internet or cheery young salespeople at a health food store.
"That healthy-looking 20-year-old in the health-food aisle may be who you aspire to look like," he says, "but he's not exactly a source of unbiased information."
Bonakdar cites several major concerns about dietary supplements. He says studies have shown, for example, that the active ingredients in some supplements are missing entirely or present at 1,700 percent of the labeled amount. Because herbs can act as active compounds, their ability to interact with other agents is similar to prescription drugs.
"It's estimated 15 million Americans are at risk for potentially adverse herb-drug interactions," Bonakdar says. For example, St. John's wort, shown in some clinical studies to effectively treat depression, should not be taken by anyone on prescription blood thinners or other supplements that have blood-thinning properties, such as vitamin E, gingko and CoQ10. The herb also has been shown to lower the effectiveness of birth-control pills and medications for HIV.
In addition to consulting a physician or pharmacist who is knowledgeable about dietary supplements, Bonakdar advises consumers to investigate the products on reputable Internet sites with unbiased information. He says that these sites include medlineplus.gov, healthfinder.gov and webmd.com. Other sites-notably consumerlab.com and naturaldatabase. com-list results of independent testing of supplements by brand name, although a fee may be required to access them. Interactions between herbal preparations and prescription drugs may be checked free at drugstore.com. Bonakdar also suggests consumers use only brands that carry a seal from USP (United States Pharmacopeia), GMP (Good Manufacturing Practice) or NF (National Formulary).
"Avoid supplements with vague dosage regimens," Bonakdar adds. A supplement label that recommends "two to four tablets one to three times a day" can be a warning of low potency.
WHEN THERE ARE CLINICAL TRIALS to support a product's claim, doctors at the Scripps Center for Integrative Medicine recommend them. For pain management, Bonakdar says feverfew can be used to treat migraines, and glucosamine, SAMe, willow bark and devil's claw may be useful in relieving arthritis pain.
Cardiologist Guarneri is enthusiastic about fish oil, a rich source of omega-3 fatty acids. Proper amounts of it can be used in the treatment of heart disease and to lower the risk of heart disease, although it should not be used in combination with blood-thinning supplements or medications.
"Red yeast rice is another wonderful supplement," Guarneri says. "It's an extract of fermented white rice, and in the proper amount, it can lower a person's cholesterol by about 15 percent."
Scripps sponsors an annual natural supplements conference, which focuses on current scientific research, interactions between supplements and prescription drugs and potential side effects of a supplement's use. The most recent, held in January, was attended by about 250 health professionals, most of whom were San Diego physicians. For more information on the Scripps center, call 858-554-3300 or go to scrippshealth.org.
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