Herbal Supplements' Unnatural Risks and Recent Scandal

As reported broadly, the Attorney General of New York State has accused four major retailers of selling mislabeled herbal products from major supplement companies, products which the New York Times describes as “fraudulent and potentially dangerous”. The AG says they contain little or none of the active ingredients and do contain fillers that are not listed on the label and might cause serious reactions in people allergic to them. The AG is taking legal action against GNC, Walmart, Target and Walgreens.

This includes many popular and widely used supplements, including Gingko Biloba, St. John’s Wort, Ginseng, Garlic, Echinacea, and Saw Palmetto.

The supplement industry is not being fair with you, in more ways than one

According to the AG, the industry is selling you some phony goods at high prices and lying on the label. That is just for starters. There are other things that most experts feel are also untruthful and unfair to consumers of supplements.

Falsehood #1: “These products are natural”.

Lettuce is natural. Eating an Echinacea plant would be natural. Taking plant materials to a factory and manufacturing them into products that can be sold in bottles, with added fillers, is the opposite of natural. It is the same thing they accuse prescription medicines of being, except that prescription medicines are very tightly regulated for effectiveness, contents and safety. Some supplements contain poor quality versions of the very prescription drugs they say they are so against, including some that have been taken off the market for safety reasons.

Falsehood  #2: “It’s natural, so it can’t hurt you.”

Invite anyone who says that to you to go out in the fields and collect some holly berries, foxglove and some common wild mushrooms, such as Amanita bisporigera. Ask them to come home with you so you will cook up a nice soup for the two of you. “That’s deadly poisonous”, they will tell you if they know anything about it. “That’s OK”, you answer, “it’s natural so it can’t hurt you.” Unlikely they would try your soup.

In fact, as explained below, all supplements have significant risks and side effects and many people have been harmed by using them.

Falsehood  #3: “This will{make you better, prevent a cold, help your anxiety, keep you young, help your memory and thinking, prevent cancer, clear your skin … and on and on, almost every promise one can imagine}.”

Sounds great – who wouldn’t want any of that, no matter the cost? Problem is, there is no proof of any reliable kind that any of these claims are true. The few herbals that have some effect, all very little, are far inferior to the real medicines for those purposes, and no safer (and some are more hazardous than the prescription drugs, such as Kava, which has caused fatal liver damage).

Thanks to two senators who get enormous contributions from the supplement industry, a law was passed in 1994, the Dietary Supplement Health and Education Act of 1994 (DSHEA). It makes it nearly impossible for the FDA to require what all prescription drugs are subject to: the supplement makers do not have to prove their claims are true and they do not have to show that they are safe.

Imagine the temptation: You can promise almost anything, you can put whatever you want into a bottle, you do not need test anything for risk to users, and you can charge whatever you want. The only thing supplements are not allowed to say is that they are a cure, which is why you do not hear that in their marketing, but you sure hear a huge number of other promises.

It is very profitable. According to Forbes, this is one of the fastest growing industries. Since the 1994 law, sales more than tripled to $32 billion by 2012.   

Falsehood  #4: “Herbal supplements are safe.”

Herbal supplements actually cause cases of serious harm and even deaths, including many commonly used products.

Some supplements have been found to be contaminated with dangerous heavy metals, pesticides, prescription medications (including some that were taken off the legitimate market long ago because of high risk) and even more. Chinese and Ayurvedic supplements are particularly prone to these, but so are many others. There is of course nothing ‘natural’ about these.

Just as bad, the supplements that do not contain contaminants are themselves toxic in some cases. Here are just a few examples of harms that common supplements have caused (far from a complete list):

  • Kava, Comfrey, Germander, Chaparral, Horse chestnut, Khat, Pennyroyal, Safrole (sassafras) have caused liver damage, leading in some cases to liver transplants.
  • Aconite (monkshood, wolfsbane), Bitter orange, Country mallow, European mistletoe, Ephedra (In many products until banned), Licorice, Yohimbe have caused high or low blood pressure, irregular heart rhythms, heart attacks and strokes.
  • Some Red Rice Yeast products, sold to reduce cholesterol, contains citrinin, a poison that can cause serious kidney injury. Even when free of that, Red Rice Yeast makes no sense anyway. It reduces cholesterol because it contains monacolin K, which is identical to Lovastatin. That was the first statin medicine approved by the FDA and sold as Mevacor beginning in 1987. It is the weakest statin; later forms, especially Atorvastatin (Lipitor) and Rosuvastatin (Crestor) have significant advantages.  Some Red Rice yeast products have almost no statin in them, and are thus worthless for cholesterol, and some have been found to have dangerously high levels of statin. Prescription statins have none of these problems.

People often take Red Rice Yeast because of a very mistaken fear of statins, not realizing that they are taking a statin in the supplement. Having a statin carefully controlled and regulated by the FDA is much better than one whose only regulation is how much money it can make for the seller.

  • So called Antioxidants are sold in many forms with highly exaggerated claims. Some antioxidants can make you worse (for example, beta carotene increases the risk of lung cancer in smokers). Most antioxidants do not get inside your cells, which is where they would have to be if they were to do any of the good things claimed for them. There is far too little data to recommend that people take antioxidant pills of any kind. On the other hand, there is enormous data that just eating a healthy diet has a very great benefit. Real food, not stuff in bottles.
  • Many supplements can cause other problems, including cancer, miscarriages, allergic reactions, kidney damage, nausea, diarrhea and vomiting, hypersensitivity to sunlight, and more.
  • Best bet – do not take supplements unless prescribed by your doctor.

Drug interactions a very serious problem

Another major problem is interactions with prescription drugs, often causing severe problems, even deaths. A number of patients who had undergone transplants suffered rejection, dying or needing new transplants, because they had taken St. John’s Wort. The marketing had led them to think it would help their mood (it has a slight effect), but they did not realize that the herb blocks the medicines that prevent rejection of transplants. Always tell your doctor what supplements you take. Unfortunately, there is nowhere near enough data on interactions between drugs and supplements for your doctor to know for sure if the combination is safe.

Vitamin supplements overdone

A vitamin is a substance your body does not make and you cannot live without. They are all found in food you eat (except for Vitamin D unless food is ‘fortified’ with it). You need very little vitamins, miniscule amounts.  Very few Americans are malnourished (our problem is that too many of us are over-nourished!) Only those with true malnutrition or certain diseases get vitamin deficient.

The value and importance of vitamins have been clearly shown for vitamins contained in the food we eat. There is no evidence that vitamin pills help anything, other than the few vitamins that have a place in treatment of some specific diseases, such as B12 for pernicious anemia (wherein absorption of B12 is defective).

Vitamin D is important for health. It is made by sunlight striking skin, but because many fewer people get sun exposure anymore (and being careful about the sun is important for skin health), more people need Vitamin D supplements, in moderation (ask your doctor).

Folic Acid is very important in pregnancy.  It helps prevent serious birth defects (‘neural tube defects’, especially spina bifida and anencephaly).All women of childbearing age are best served if they make sure they get 400 micrograms of folic acid daily, way before they might become pregnant.

From the CDC (Center for Disease Control and Prevention): “The U. S. Public Health Service and CDC recommend that all women of childbearing age consume 0.4 mg (400 micrograms) of folic acid daily to prevent two common and serious birth defects, spina bifida and anencephaly. All women between 15 and 45 years of age should consume folic acid daily because half of U.S. pregnancies are unplanned and because these birth defects occur very early in pregnancy (3-4 weeks after conception), before most women know they are pregnant. CDC estimates that most of these birth defects could be prevented if this recommendation were followed before and during early pregnancy. (http://www.cdc.gov/ncbddd/folicacid/recommendations.html

Excess vitamins are also not helpful, other than as prescribed for certain diseases, and they can be harmful.  For example, high doses of Vitamin A given to young children can cause serious brain damage and even death. Too much Vitamin C can lead to diarrhea and kidney stones.

Remember that we need only tiny amounts of vitamins daily. When vitamins are used in excess of that, they become medications, and as such should be used only for well proven needs and safety.

Mineral supplements

Mineral supplements are likewise of little or no value except in specific, scientifically determined cases, such as the examples below.

Minerals in excess can also cause harm. For example, too much Zinc, alleged to shorten colds slightly, can lead to anosmia, the loss of smell. Some products contain very high levels of selenium (as do Brazil nuts, which should be eaten in strict moderation). According to the National Institutes of Health (see link below), acute selenium toxicity can cause severe gastrointestinal and neurological symptoms, acute respiratory distress syndrome, myocardial infarction (heart attack), hair loss, muscle tenderness, tremors, lightheadedness, facial flushing, kidney failure, cardiac failure, and, in rare cases, death

Adequate calcium intake is important for everyone. Most of what you need will come from the healthy way of eating described in detail elsewhere, but some people require supplemental calcium pills.

Some people are low in iron and need supplemental iron pills (very important to always make sure all possible causes of iron loss are tested beforehand).

Not only a risk to your health, a waste of your money

These supplements are very expensive. One product advertised widely on the radio claiming  to improve thinking contains only some vitamins and the usual common herbs, yet if taken as directed would have cost $3,600 per year, without any acceptable evidence that it would do anything. A patient with eight children on Medicaid was found to be spending $3,000 per year on supplements despite the ‘discounts’ she said she was getting. She just wanted to do right by her family and had no way of knowing that she was not only wasting money but possibly exposing her family to serious harm.

Selling supplements is problematic in many ways in far too many cases. Making unproven promises, allowing contaminants, selling potentially risky medicines without warnings should all be unacceptable. It seems far safer for consumers if the 1994 Act were to be repealed and all of these supplements be made to provide proof that they work, are reasonably safe and that they are absolutely pure, just as required of prescription drugs.

Discouraging treatment that is actually effective

In promoting supplements, a common technique is calling legitimate medical practice a profit-seeking conspiracy to push dangerous and unwanted treatments on people. While a good description of how herbal medicines are sold, it grossly and unfairly describes scientific medical practice, which has saved hundreds of millions of lives and helped even more to be healthy and able to enjoy life. Vaccines and prescription medicines have eliminated many age-old scourges that killed and maimed millions of people before their availability.  The only conspiracy doctors are guilty of is conspiring to help people stay alive and be healthy.

Unfair to you

What seems especially unfair is that the alternative medicine industry preys on the very understandable desire of people to be healthy and to do the best for their families.  People have limited ways to try to tell who is telling them the truth and who is not. In legitimate medicine, the principle is informed consent, meaning advising patients fully and completely of all the pros and cons of recommended treatments and to ensure that the evidence is strong, so that you can make your decisions based on facts, not promises. That level of fairness is sorely lacking in the supplement business.

‘Alternative’ medicine makes no sense. If you can prove it works reasonably well and is reasonably safe, then we should all use it in real medical care, as we do for therapies such as meditation, mindfulness and exercise. If you cannot show it works and is safe, then why would anyone use it?

Unproven to work, potentially harmful to your health, overpriced and sometimes fraudulent, unfairly deterring you from treatments that can actually help – maybe supplements are not what they are claimed and maybe you want to rethink using them.

Where to get more information

The National Institutes of Health Office of Dietary Supplements maintains an excellent website to provide detailed, up-to-date knowledge about dietary supplements.

It can be found at:

http://ods.od.nih.gov/HealthInformation/makingdecisions.sec.aspx