A version of column was published in USA Today on November 20, 2013.
I once diagnosed a patient with high cholesterol, and prescribed him a medicine commonly known as a statin. When I saw him months later for follow-up, he admitted that he didn’t fill the prescription.
“I took red yeast rice capsules instead,” he said.
When I asked him why, he told me that he was wary of statins’ long list of side effects and felt taking a “natural,” over-the-counter cholesterol-fighting supplement was safer.
When it comes to herbal supplements, I generally inform patients that most have little evidence to suggest that they actually work, but leave the ultimate decision of whether to take them to patients. But given the results of recent studies, I wonder if patients are better off avoiding these supplements altogether.
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Americans spend $5 billion a year on pills like echinacea to ward off colds, ginkgo biloba to improve memory, or black cohosh to improve postmenopausal hot flashes. There are over 29,000 herbal products sold throughout North America, with about half of Americans using some form of alternative medicine. Many believe that since these products are promoted as natural or organic, and legally sold and marketed, that they are safe.
That’s not necessarily true. While smaller studies have previously suggested that herbal supplements are often not what they seem, an October 2013 study from BMC Medicine used DNA analysis to provide the most definitive evidence to date. Researchers looked at 44 randomly selected supplements, and found that one-third had no trace of the plant advertised on the label. Consider two bottles of St. John’s wort, for instance, used to treat depression. One contained pills that had no evidence of the advertised herb, while the other substituted another plant that happened to be a known laxative.
According to David Schardt senior nutritionist of the Center for Science in the Public Interest, “This suggests that the problems are widespread and that quality control for many companies, whether through ignorance, incompetence or dishonesty, is unacceptable.”
But this goes beyond false advertising. Herbal supplements can cause real health damage. In 2012, the FDA blamed them for causing over 50,000 adverse events annually. Some pills use fillers that are made up of rice, or worse, black walnut, which can severely affect those with nut allergies, while others contain unlabeled toxic ingredients. Many also interact with prescription drugs, like garlic and ginkgo biloba which can potentiate the effect of blood thinners and cause life-threatening bleeding.
Furthermore, data presented in early November at the American Association for the Study of Liver Diseases meeting found that liver failure caused by herbal supplements, especially those used in bodybuilding, increased almost three-fold from 2004 through 2012.
Despite the data, many patients I see in my clinic feel that supplements are safe, sometimes even preferring them to prescription drugs. This reflects the mindset of the majority of Americans who falsely believe that herbal pills have to be FDA-approved before sold. Patients also may not be aware that up to 70% of herbal drug producers violated manufacturing guidelines designed to prevent adulteration of their pills.
Of course, prescription medications have the potential of uncommon, and in rare cases, serious, side effects. But these drugs are regulated by the FDA, so at least we know what’s inside them, and what’s inside them works. That’s certainly far more than we can say about the vast majority of herbal supplements patients take today.
Kevin Pho, MD, is a practicing, board-certified internal medicine physician and the founder and editor of KevinMD, which he built from scratch in 2004 to give clinicians and patients a place to be heard. Over two decades, it has become one of the most recognizable physician-led publications in health care, drawing more than 7 million annual page views and over 500,000 followers across social media. He still sees patients in primary care in Nashua, New Hampshire, the practice he says keeps the platform honest.
He is the host of The Podcast by KevinMD, a daily, 15-minute show that has surpassed 2,000 episodes and 2.6 million IAB-certified downloads, featuring physicians, patients, caregivers, founders, and health care leaders in conversation about what they actually see and do. He is also a national media commentator and the coauthor of Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices.
An acclaimed keynote speaker, Kevin speaks nationwide to clinicians and non-clinicians on health care, digital media, physician leadership, and burnout. His signature keynote, “Connect and be heard: Make a difference in health care with social media,” traces his social media journey since 2004 and inspires audiences to strengthen the doctor-patient relationship, make their voices heard in health reform, and turn the tide against clinician burnout. He is the founder of Physician Speaking by KevinMD, a physician-run speakers bureau, and is available for speaking opportunities.
Kevin earned his medical degree from Boston University School of Medicine and completed his internal medicine residency at Boston University Medical Center. The New York Times called KevinMD “a highly-coveted publishing place for doctors and patients,” and Forbes called it a “must-read health blog.” He is an inductee of the Healthcare Internet Hall of Fame, a recipient of the American Medical Writers Association McGovern Award, and a New Hampshire Magazine Top Doctor.
