According to a study published in the New England Journal of Medicine, the use of dietary supplements sends an estimated 23,000 Americans to the emergency department each year. Approximately 25 percent of the ER visits that were supplement related were by adults who were using herbal weight loss products. Another 10 percent were caused by adults consuming “energy products” (although people using energy drinks were excluded from the study). Most of the people came in complaining of cardiac symptoms: palpitations, chest pain or rapid heart rate.

Not all preparations that caused problems were for weight loss or improved energy. In 2007, there was a report of 10 cases of fulminant liver failure caused by products marketed by the Herbalife® corporation. Other supplements containing green tea extract have been linked to liver failure. Recently, former NBA star, Lamar Odom, was found unresponsive after reportedly taking Reload a supplement sold for sexual enhancement that contains Viagra.
For something that’s supposed to be “healthy” and non-toxic, that’s a lot of ER visits, and a lot of side effects. Granted, it doesn’t hold a candle to estimated 18,000 deaths caused annually by prescription opiates, but still supplements are supposed to be healthy, and not cause any problems, right?

However, a quick survey of the literature is replete with studies showing adverse reactions from herbal supplements alone or between herbal supplements and medications. And the problem only seems to be worsening. Between 1994 and 2012, the number of herbal or complementary products rose from 4,000 to more than 55,000. By 2007, the herbal industry had become a $14.8 billion business. If the FDA can demonstrate that the supplement is unsafe, it can restrict its use: more than 200 dietary supplements were recalled between 2004 and 2012. But the FDA really doesn’t have much say so in the use of these drugs.

Federal law was changed in 1994, so dietary supplements no longer need approval from the FDA before they can be marketed. This has turned the market for dietary supplements and herbal medications into a buyer beware free-for-all. This has been made worse by the fact that many of these supplements can be sold over the Internet, so consumers really have no idea what they are getting. In 1994, GNC settled a lawsuit by the Federal Trade Commission for deliberately mislabeling many of their supplements; many not containing any of the stated ingredient.

Although supplements containing ephedra were supposedly taken off the market ten years ago, there are still supplements out that do contain ephedra, which has been linked to sudden cardiac death in a number of high schools and college athletes. A 2008 study in the Journal of Mass Spectrometry found 634 supplements that were contaminated with anabolic steroids. Some of these contaminated supplements were Vitamin C and magnesium tablets. They also found that nutritional supplements were adulterated with the stimulants ephedrine, caffeine, methylenedioxymethamphetamine (MDMA, “ecstasy”) and sibutramine (Meridia, a prescription-only weight loss drug).

This is a problem unique to the United States. In Europe, the herbal industry is as stringently regulated as the prescription medication industry. When a person purchases an herbal remedy from a European vendor, he can be sure that he’s getting what he’s supposed to be getting. In the U.S., however, one really doesn’t know for certain that the bottle contains what it says it does.

Even “safe” herbs taken for appropriate reasons can have adverse effects, or interact in a variety of ways with prescription meds. Gingko Biloba has a very strong interaction with prescribed anti-coagulants like warfarin in people who must take this med for a variety of conditions. It also interacts with medications like ibuprofen and aspirin. Even grapefruit juice can have an adverse interaction with the cholesterol medication, simvastatin (Zocor). If we add this to the fact that we may not actually know what we’re taking, we have the recipe for potential disaster.

There is a role for herbal medications in our armamentarium: Turmeric has shown to be beneficial in treating osteoarthritis; cinnamon has some usefulness in helping to control blood sugars in diabetics; valerian, when taken judiciously can be a useful sleep aid. There are many other useful herbs and supplements, although, as a general rule, Americans take way too many vitamins in a feeble attempt to make up for a nutritionally poor, carbohydrate-rich diet.

Just because something is herbal or natural doesn’t necessarily mean it’s safe. As I tell my patients, both arsenic and strychnine are natural, but they sure aren’t safe. If someone wishes to take an herbal supplement, he or she should have a good idea of why he/she is taking it and talk to his/her physician to make sure it won’t interact with other medications they may be taking. More and more physicians are amenable to their patients taking supplements, but they need to know what those supplements are. But equally important is that we need the FDA to look into these products, reclaim regulatory jurisdiction over their manufacture and sale, so that all of us may be sure that we’re taking what the bottle says we’re taking.

Until that day arrives, however, know the company you’re buying the supplement from, and buyer beware.

Stephen Kamelgarn is a family physician who blogs at Code Blue Health Crisis.

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