Herbal supplements may be natural, but that doesn’t mean they’re safe

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.

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.

Herbal supplements may be natural, but that doesn’t mean they’re safeKevin Pho is an internal medicine physician and co-author of Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices. He is on the editorial board of contributors, USA Today, and is founder and editor, KevinMD.com, also on FacebookTwitterGoogle+, and LinkedIn.

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  • Kristy Sokoloski

    Very well said. And I have met some people who get very judgmental as well as nasty toward those that choose not to take herbal supplements but go with the recommendations of the doctor for the prescription. I have had to tell some of these people that make the kind of judgmental and nasty comments that they do that they don’t know the full situation of the other person for why they take the conventional route. And these people think they are justified in trying to play ‘doctor” not realizing that what they tell these people can be very harmful. I see a lot of these kind of attitudes in online support groups for various health conditions such as Fibromyalgia. And that is in addition to those that want to lump all doctors (yes, including the good ones) together and bash them because they can.

    • GT

      Some of them really bash parents who are having their children’s leukemia treated via traditional science-based medicine too, castigating them for “falling for the Big Pharma scam” and poisoning their children, when what they really should be doing is {insert various types of quackery and woo here}.

      Well-moderated online cancer communities are able to kick these people out before they do too much damage, but on unmoderated boards (as you are probably aware through your own online experience) they can swoop in en masse and suddenly become the dominant voice.

      • Kristy Sokoloski

        That’s good that the online cancer support groups are able to kick these kind of people out of the groups before they do too much damage. I wish the same could be said about the other kinds of online groups. And when someone comes along and tries to defend doctors for trying to help the people they in turn get flamed.

  • Ron Smith

    Hi, Kevin.

    The absolute debauchery of the ‘natural supplements’ industry is appalling, but also is the unexplainable lemming-like affirmation that patients and parents toward anything touted to be ‘all natural.’ It reminded me of how I feel every time a commercial says ‘doctors recommend.’ When I last checked, I have never been quizzed about their product?

    I treat a lot of ADD children and have for thirty years. What amazes me is the extent to which these kinds of frauds continue to churn generation after generation.

    One of the worst ‘treatments’ I ever saw was when the parents of a patient told me that they had paid for 6 weeks of special computer biofeedback that guaranteed a cure for their sons ADD. Two months and $6,000 after they started that ‘treatment’ they were in my office for a dose of real ‘medicine’ (pardon my pun, but it was intentional).

    Repeatedly I have hammered away at the continually promulgated misinformation that sugar, dyes, and certain foods cause ADD. I explain to parents that repeated studies, ad nauseum, have debunked those explanations over the last 40 years.

    The latest attack angle on these desperate parents is by the ‘health food supplement’ industry that is hawking various products which will fix a child’s attention problems. To think that this industry which touts specific medical benefits is not under FDA scrutiny is both problematic and curious.

    I mean, if the FDA can unilaterally decide to remove all the OTC cough and cold medicines for children under 6 from pharmacy shelves, why is the long arm of bureaucratic government choking off this ‘all natural’ nonsense? I mean what’s to stop the local roadside psychic from promoting their form of witchery to ‘cure’ my ADD patients?

    It is one thing though to say these herbal supplements just don’t work, but quite another to say they don’t even contain what is on the label! Where is the US justice department when you really need them protecting and defending us? I mean free speech in advertising does not mean that you can tell such frank untruths about your product.

    Thanks for the great article.

    Warmest regards and Merry Christmas
    Ron Smith, MD
    www (adot) ronsmithmd (adot) com

    • GT

      They’re too busy trying to ban free adult citizens from having their own DNA analyzed without giving kickbacks to the Medical Industrial Complex, to bother doing anything about supplements and treatments which are nothing but useless and sometimes dangerous quackery and woo.

    • rbthe4th2

      Hey Dr. Smith
      Would you believe I was one of the parents fussing that I won’t take a supplement without the testing and approval of my doctor, but I had to go through over 5 doctors to get tested? Even better, the tester recommended a vitamin that doesn’t have any of the vitamin I’m so low in that I don’t register? Or that it has only 31% of the one that is low but at least measureable? Or that it has so much of the mineral I’m so high in that it would push me over the edge to toxicity recognized in medical literature?
      This is with signs/symptoms that point towards nutritional/vitamin problems.
      For this I am castigated … no lie! I even put in my chart emails I want to work with a doctor so that I do this logically and appropriately.
      I’m glad to see at least ONE doc appears to know something about the issue.

    • Patricia

      I think that people who have ADD and children with ADD are not ‘lemming-like’~ that discounts the knowledge parents have of their children, but that they don’t want to see their kids suffer from side effects of ADD drugs. For example: exacerbating tics, major anxiety, emotional crashing,insomnia, anorexia, suicidal ideation (from the anti-depressant medications). Some people cannot tolerate ADD meds and they need *something* because this world is not structured in a way that is conducive to the success of those with ADD. Instead of ranting about these ‘lemming-like’ parents,why not advocate for studies of alternative methods of treatment? (And I do agree that if a parent is spending $6000 on a treatment that doesn’t work,that is not good and shouldn’t be allowed to happen)

  • Dr. Drake Ramoray
  • http://womanfoodshinyobjects.wordpress.com/ Brian Stephens MD

    Rattle snake poison is natural too. Dont make it good for you.

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