Archive for August, 2016

PART 2—Supplements—the good, the not-so-hot, and the potentially ugly

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Next week I get to cover the more fun stuff—some surprising supplement benefits, pointers on their use and thoughts on why they are still controversial. However, today I had better finish telling the rest of the story about the 15 supplements that the Consumer Reports (CR) September cover article says to avoid.

Kava – I addressed this controversy in the blog on July 28. But, just to quickly review, Kava has a long-held and justly deserved reputation for helping relieve anxiety, insomnia and pain without compromising mental sharpness. The controversy arose when the herb was mistakenly blamed for trouble caused by the careless use of the wrong part of the plant. That carelessness (or deceit) also explains why sometimes herbs don’t work. (E.g. maybe the bark is what works, but a sleazy operator will use the leaves instead because they are cheaper.)

Lobelia – (Hehe…it is also known as “pukeweed”). This herb is used mostly for asthma, congestion and bronchitis. About 80% of the consumer reviews on Lobelia are 5-star. High doses can cause nausea and dizziness. That is not ideal, but in contrast, I am always amazed to hear in a TV commercial for an asthma pharmaceutical stating that one of the many potential side effects is “asthma-related death”.

Methylsynephrine – This chemical does not meet the FDA’s definition of a supplement. It is banned but that doesn’t keep some fringe body building, athletic and weight loss products from slipping it in. When the FDA catches them, the agency stops them.

Pennyroyal Oil – This member of the mint family was added to food in the middle ages and was used by our early settlers to repel rattlesnakes. Although there is a history of use as an herbal medicine, I did not find it for sale as a supplement. Today the essential oil is used as aromatherapy.

Red Yeast Rice (RYR) – This supplement is widely used to lower cholesterol by blocking its production in the liver. Although RYR is generally believed to be safe, it should not be used by persons already taking statin type cholesterol-lowering drugs or by those who have liver disease. CR lists some side effects for RYR. They should mention that those are rare, but with the statin drugs used for cholesterol those same effects are more severe and more common.

Usnic Acid – CR is right. This substance, found in lichens, can harm the liver and serves as a reminder that not everything that occurs naturally is safe to take willy-nilly. However, I was only able to one foreign pill that contains it and two herbal liquids designed for only professional use. So, not something you are likely to stumble on.

Yohimbe – It is not hard to find this herb because it appears in many male enhancement and body building supplements (even from mainstream companies). Yohimbe should be used under doctor’s supervision. I’m not a big fan. A high percentage of pharmaceutical drugs originated as herbs. The herb is safer, but any that are very powerful can also be tricky. I’m more comfortable using herbs for nutrition, prevention and minor issues. Homeopathics are a safe, effective approach that is underutilized.

So, in summary, the 15 warnings given in the CR article delivers more scare tactics than useful information.

Sometimes individual herbs are not an issue, but a combination of several might be. For example, I began corresponding with Carla, an endearing nurse at a prestigious hospital. (She had commented on a newsletter where I mentioned Dr. Linus Pauling who had been a patient). Carla told me that a woman was waiting for a liver transplant because she had taken a “Detox” supplement. (The patient had admitted that she was very sensitive and should have known better.) That supplement package contained over 30 ingredients including some very powerful herbs and laxatives. (BTW, that is not my idea of how to detoxify. I’ll soon have a video outlining a better approach.)

I mentioned to Carla that  I wondered how many liver transplants Tylenol (acetaminophen) was responsible for. Her reply was: “Oh, tons….and I’ve known of several people who needed liver transplants…people even manage to commit suicide with it [Tylenol].” Statistics show that this seemingly safe over-the-counter FDA-approved medicine is the leading cause of acute liver failure. And yet, it is marketed in medicine for children. Sigh…It is a funny upside down world we live in.

Supplements—the good, the not-so-hot and the potentially ugly—Part 1

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In “Supplements—the good, the not-so-hot and the potentially ugly—Part 1” I begin to give the rest of the story on some recent supplement warnings. You probably know that nutritional and herbal supplements can be very beneficial. In two weeks, I will discuss some particular benefits; give a few pointers on their more effective use and suggest why supplements remain controversial.

However, it is clear that not every supplement is good for every person at any dosage and at all stages of life. That is one useful point made in the Consumer Reports September cover article. The magazine gives a list of 15 supplement ingredients to always avoid. The medical editor has admitted to a bias against supplements and the list is used in a way that seems designed to purposely paint a bleak picture. However, the list is a “teachable moment” as they say. So that this blog post doesn’t get too long, I’ll cover the 8 of the list this week and finish up the other 7 next week.

Aconite – Why was this item even on the CR list? Aconite is not used as a supplement. (Fun fact: in the past it was used to poison the tips of arrows.) One the 250 species was used (I presume very carefully) as a medicine in ancient Greece. But today, it is only used in homeopathic remedies. In homeopathic form, a toxic substance is safe and can be very healing. Is aconite on the list as a scare tactic or does it just reflect a lack of knowledge? Could be. I have run into pharmacists who do not understand the principles and dilutions of homeopathy and are freaked out by the starting material. See next item.

Caffeine powder – Everyone knows that you can overdose on espresso shots or NoDoz® and experience side effects like rapid or irregular heartbeat and even seizures. People who do not tolerate caffeine would probably know to avoid this ingredient. A homeopathic version of coffee (coffea cruda) works to calm a racing mind and do the opposite of the other symptoms caffeine can generate.

Green Tea Extract Powder – Green tea contains some extremely beneficial compounds such as EGCG. However, it does contain caffeine although less than coffee. Overdoing it can have the same issues as caffeine noted just above. The most common risk lies in not noticing that multiple sources of stimulants add up. An example would be combining a weight loss product, an energy drink and Mountain Dew (high caffeine content).

Chaparal – This herb is quite powerful and native Americans knew how to use it for cancer. It is anti-inflammatory, but, can have negative effects in the wrong hands and wrong dose. (The same can be said of most anti-inflammatory drugs.) I could only find one fringe company that even makes it. Chaparal is not commonly used except perhaps by a few master herbalists who know how to do so safely.

Coltsfoot – This is a rare supplement, but not impossible to find. It has been used for coughs, but there are many other choices that don’t pose a risk to the liver when used in high doses.

Comfrey – Do an online search for this and you will find salves and a very few extracts which can be considered supplements. But, look carefully, the labels say “for external use only”. One product comes up, “ComFree”, is actually an alternative to comfrey that contains none of the herb. Harmful to the liver? It could be, but the thing is, people are not swallowing it.

Germander – I had to really dig on this one to find anything except web pages warning not to use it. One obscure foreign male enhancement product apparently used to contain it in the past but no longer does.

Greater Celadine – You would have a hard time finding this, but if you did, caution is warranted. Dr. Ohhira’s Probiotics would be a much better choice for stomach ache.

To be continued…Meanwhile, we can avoid trouble by sticking to mainstream manufacturers with a reputation to uphold. Do not fall for the hype of fly by night sellers of particularly weight loss, body building and sexual enhancement products. Also, be especially leery of outrageous claims of overnight success. Those are often the fringe operators who are most likely to try sneaking pharmaceutical drugs into their products.

Dietary supplements really are regulated

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Considering the spin that the FDA and the likes of Consumer Reports give supplement regulation, a person might think it is risky to buy vitamins and other supplements in a health food store. However, I assure you that it isn’t the wild, wild West. Dietary supplements really are regulated. Ask any reputable on the radar manufacturer. They feel more than adequately supervised. In fact, they can even be vindictive. I know one owner who got a little cutesy with an FDA inspector and soon had visits from every local authority, the IRS, OSHA (safety), and even Alcohol Tobacco and Firearms (because he used a bit of vodka as a preservative in a sinus spray.)

As I pointed out in last week’s blog covering Consumers Report’s confessed bias against supplements, it would be patently ridiculous to regulate these food-like substances in the same way we do drugs. A person doesn’t need a prescription to buy a bulb of garlic, so why should we need one to buy garlic that someone has dried and put in a capsule? Pharmaceutical-type regulation would, in practical effect, take supplements off the market. Below is some basic information taken from a press release by the Natural Products Association. (I was once NPA’s president when it had another name.) These facts may help balance the scare tactics so often publicized.

  • Supplements are regulated by the Food and Drug Administration (FDA) as a special category of food. There are legal requirements for facility registration and the law requires use of good manufacturing practices (cGMPs) for sanitation and quality control. In addition to that, our Texas Department of Health also keeps a close eye on manufacturers and I believe that is true in most other states.
  • Dietary supplements have a fantastic safety record, especially when compared to medication and incidence of hospitalization from illness due to problems in the food supply. As we know, food can sometimes be contaminated. Periodically everything from spinach to peanut butter and ice cream are in the news. The safety record of supplements is much better than food in part because much of the process is automated and the ingredients are often dry and therefore less subject to spoiling.
  • Supplements are currently the only food commodity to require mandatory Serious Adverse Event Reporting (SAERs). Curiously, those requirements are the same or, in some cases, even more involved than those for potentially dangerous pharmaceuticals. The large numbers of complaints quoted by Consumer Reports is based on a mathematical estimate not an actual number of SAERs from the FDA. And, as I mentioned last week, it is highly likely that in most cases the supplement was just an innocent bystander to an event caused by another factor. That said, it is possible to use supplements inappropriately and next week I will offer some cautions.
  • The FDA also has strict requirements for how supplements are labeled. Companies get in very big trouble if the ingredient or dose in a pill is different than what is stated on the label. The FDA also tightly limits what a manufacturer can say about the supplement’s benefit. (That is why labels usually seem so frustratingly vague.) The Federal Trade Commission (FTC) has primary responsibility for regulating the advertising of supplements and sets a high bar for proof of claims.
  • If an ingredient has not been in commercial use before, there are very tough requirements for marketing it.

As I said, dietary supplements are regulated. New regulations are not needed, but the existing rules could surely be enforced more uniformly. For years, the NPA has called for full implementation of the cGMP regulations and has pushed for the FDA to be given more funding so that they could hire enough inspectors. The NPA has also fully supported government efforts to crack down on illegal drugs being marketed as dietary supplements.

So what is the big stink about? Most of us in the nutrition world think that the underlying problem is the amount of money being made in pharmaceuticals and the FDA’s close ties to that industry. The very idea that people can stay healthy or heal using non-patentable supplements is unsettling to the establishment.

Of course, there are shady operators on the fringe of any industry. For example, what could be more tightly regulated than the distillers of alcoholic beverages? And yet individuals still sell moonshine. The vast majority of supplements carried in responsible stores are safe and appropriately labeled. Next week I’ll discuss why supplements are being used more frequently even in mainstream medicine. I’ll also tell which ones to stay away from.


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