TODAY’S COLUMN: Kami Whitney, PA-C, talks about the case against supplements

Supplements. They are in the grocery store, health food stores, on TV and in your Facebook feed. They tout a variety of benefits from decreasing pain, improving sleep or mood to weight loss, or muscle gain. Many claim to be “all natural.” Have an ailment? There is likely a supplement for that. 

Before you head off to the store to find a “natural” remedy for your malady, we would like to offer a few tips before you pick one off the shelf.

Know the difference between a medication and a supplement. The US Food and Drug Administration’s (FDA) Center for Drug Evaluation and Research (CDER) oversees both over the counter and prescription medications that are brought to market.

Before medications can be sold, they must prove that they are both safe and effective for the condition they are meant to treat. After approval, the CDER continues to monitor medications for safety. 

On the other hand supplements are considered a food and are subject to oversight by the FDA’s Center for Food Safety and Applied Nutrition (CFSAN). Supplements are not subject to investigation for effectiveness by the FDA.

Supplement manufactures don’t need to provide proof of its effectiveness for any condition, and the FDA only needs to review new ingredients for safety.

All natural, does not mean free of harm. While the FDA does monitor for safety, this does not mean that there are no harms from supplements.

Many common supplements are known to interact with common prescription medications, but are not required to list these possible interactions in their labeling.

For example: ginkgo biloba, a supplement probably meant to help with memory, can thin the blood. When combined with the common prescription blood thinner Coumadin, there is the potential for increased bleeding in these patient.

St. John’s Wort, a supplement commonly used for depression can decrease the effectiveness of prescription medications for birth control, HIV and cancer, could worsen anxiety and in rare cases cause psychosis.

Buyer beware. Regulation of supplements is so poor that a recent New York State investigation revealed that 4 out of 5 supplements tested had no trace (by DNA testing) of the plant that was advertised.

In 2013 a USA today investigative report found that some “herbal” supplements for sleep actually contained Thorazine, a prescription anti-psychotic. Another “sexual enhancement” supplement had tadalafil, the erectile dysfunction medication brand named Cialis. Both medications can lead to serious side effects for some patients.

Vitamins and Minerals. These fall into the same category as herbal supplements. In addition to the previous cautions, consumers should be aware that there can be “too much of a good thing.”

Too much of some supplements can cause troublesome side effects. Excess magnesium can cause diarrhea, too much iron may lead to constipation. Vitamin E and Vitamin D can thin the blood and excess Vitamin B6 can cause problems with nerve conduction as well as nausea and heart burn.

Higher doses of any vitamin or mineral may be too much for the body to absorb at one time. The money spent for these higher dose supplements ends up going down the drain, literally.

The Bottom Line. Talk to your provider about which supplements you are considering taking and why, before taking them. Always include vitamins and supplements when asked for your medications by any health care professional.

If a supplement is right for you, look for products that have been approved through The U.S. Pharmacopeial (USP) Dietary Supplement Verification Program.

This voluntary program ensures that the vitamin or supplement contains what is advertised at the specified amount, does not contain harmful levels of contaminants, and has been manufactured according to FDA Good Manufacturing Practices. Supplements that adhere to these measures of quality will display a USP Verified logo.

Many of our patients read the package inserts of all their medications, similar information is available on the National Institute of Health (NIH) site listed below for many common supplements and is a good resource for scientific research behind their use.

NIH Dietary Supplement Fact Sheets:
https://ods.od.nih.gov/factsheets/list-all/

For more on FDA supplement regulation:
http://www.fda.gov/Food/DietarySupplements/UsingDietarySupplements/ucm109760.htm

For more on the USA Today investigation:
http://www.usatoday.com/story/news/nation/2013/12/19/dietary-supplements-executives-criminal-records-spiked/4114451/

More here:
https://www.washingtonpost.com/news/morning-mix/wp/2015/02/03/gnc-target-wal-mart-walgreens-accused-of-selling-fake-herbals/

Kami Whitney is a certified Physician Assistant at Arjun Medical Center in Gainesville, Virginia. Arjun Medical Center, headed by Alok Gupta, MD, specializes in Internal Medicine offering services for all adults. Visit them on the web at http://www.alokguptamd.com call ,(571) 248-6666 or follow them on Facebook at Arjun Medical Center, PC.