When Natural Equals Danger
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When Natural Equals Danger

Just because a remedy is sold in a drug store, doesn't mean it is safe.

Untested, Untried, Sometimes Untrue

Forty-two percent of Americans have tried a natural remedy. And consumers spend billions each year on these alternative therapies. Many are making common -- and potentially deadly -- mistakes. Here's what you must know before you try that next remedy.

Mistake #1: Assuming the FDA Regulates Natural Remedies

They don't. In 1994, in response to a tremendous lobbying effort on the part of supplement manufacturers and consumers, Congress passed the Dietary Supplement Health and Education Act, which changed the way the industry was regulated. That means vitamins, minerals, herbs, botanicals, amino acids (often used for bodybuilding) and other "natural" substances you see on the shelves are not tested, reviewed or approved by the FDA. The FDA steps in only if a product is reported to have caused injury or illness.

However, the FDA does have rules regarding labeling. Labels must include a complete list of ingredients and net contents of the product (such as the number of pills in the bottle). In general, the label cannot contain health claims regarding prevention or cure of a disease or illness. Even so, products can be mislabeled. For instance, in 1997, the FDA discovered that certain supplements labeled as containing plantain, an herb used as a laxative, actually contained digitalis, the botanical origin of many heart drugs. Digitalis can cause low blood pressure and abnormal heart rates, posing a potential risk to unsuspecting heart patients taking the product.

Safety strategy: Buyer beware -- always remember that natural remedies have not been government tested and approved.

Mistake #2: Believing "Natural" Means Safe

The truth is, there are plenty of botanicals that are indeed harmful, especially in high doses. Since 1994, the FDA has received more than 3,200 reports of supplement-related adverse events, including liver damage or failure, kidney failure, seizures, stroke and death. The supplements in question include herbs such as chaparral (promoted as an antioxidant remedy for acne, cancer and more), comfrey (used to heal wounds), germander (for weight loss), willow bark (a fever reducer), and even vitamins A and B6 and minerals niacin and selenium.

Currently being examined by the FDA are products containing ma huang (ephedra), which is in many herbal weight-loss preparations. It has been associated with hundreds of serious incidents, including hypertension, rapid heart rate, nerve damage, psychosis, stroke, memory loss, and in at least four cases, death. Herbal weight-loss preparations also often contain the plant-derived laxatives senna, aloe, cascara, rhubarb root, buckthorn and castor oil. Overuse of these has led to severe diarrhea, vomiting, nausea and impairment of colon function.

Safety strategy: Think of supplements as drugs and treat them with the same caution you reserve for prescriptions. "In fact, about one third of our prescription drugs come from botanical origins," says Rebecca Costello, Ph.D., deputy director of the Office of Dietary Supplements at the National Institutes of Health. Don't take more than the recommended dosage, and report any side effects immediately to your doctor and the FDA's MedWatch program (800-332-1088). In addition, the American Council on Science and Health advises consumers to avoid supplements that contain chaparral, comfrey, ephedra, gamma butyrolactone, germander, lobelia, wormwood or yohimbe.

Do Your Own Research and Don't Overdose

Mistake #3: Trusting the Manufacturer's Claims

Lose 18 pounds in three weeks? Find peace of mind without taking antidepressants? A recent survey found that 57 percent of regular users of dietary supplements believe that the advertised claims of the manufacturers are generally true. Indeed, some supplements have shown promising results: Vitamin E may protect against certain forms of cancer, and echinacea may diminish cold symptoms.

Yet the survey also discovered that many people so strongly believe in the power of their supplements that they would continue using them even if a scientific study found the remedies to be ineffective. "There is disaffection between the public and the medical profession," says Marianne Legato, M.D., founder and director of the Partnership for Women's Health at Columbia University, in New York City. "The perception is that we are spending less time with patients and so they have turned to alternative sources to maintain and improve their health."

Safety strategy: Don't believe everything you read, at least when it comes to manufacturers' claims. Instead, do your own research: What is the scientific evidence backing the supplement? Have studies been published in respected medical journals? And remember, if something sounds too good to be true, it is.

Mistake #4: Supersizing Your Dosage

It's tempting to think that if a little of something is good, a lot must be better. Nothing could be further from the truth when it comes to natural therapies. "There are serious downsides of taking too much of anything," warns Ruth Kava, Ph.D., R.D., director of nutrition for the American Council on Science and Health.

More than 10,000 IU a day of vitamin A may damage the liver; more than 100 mg daily of vitamin B6 may cause nerve damage, and 800 to 1,000 mcg a day of selenium may cause depression. As a result, the National Academy of Sciences, which is responsible for establishing the Recommended Daily Allowances (RDAs), has set tolerable Upper Intake Levels (UL) levels for many vitamins and minerals-basically, the most you can take without risking your health. For example, the UL for vitamin A is 9,900 IU, for vitamin B6, it's 100 mg; and selenium's UL is 400 mcg.

With botanicals, dosing is more complicated since they've been studied less, and oftentimes the safe or effective dose is unknown. If you're not sure how much of a product to take, check with your doctor or pharmacist.

Another consideration with dosage is whether you're taking the treatment short- or long-term. Consider echinacea. Normally, the herb is taken for a week or two to stunt the duration and severity of colds and flus. However, it's often marketed like a multivitamin, with some manufacturers advising daily doses over an extended time. "It's not a good idea to stimulate your immune system on a daily basis," says Adriane Fugh-Berman, M.D., assistant clinical professor at George Washington University School of Medicine, in Washington, D.C., and author of Alternative Medicine: What Works (Williams & Wilkins, 1997). In fact, some studies of extended echinacea use suggest it may increase risk for colds and flus.

Safety strategy: Do not exceed the UL dosage for anything you take.

Consult Your Doctor

Mistake #5: Keeping Your Doctor in the Dark

More than 60 percent of consumers admit they don't tell their doctor about their supplement use, according to a study published in the Journal of the American Medical Association (JAMA). That practice can have serious repercussions. For starters, side effects of supplements can mimic or mask another health problem. "I've had patients come in complaining about dizziness," says Bimal Ashar, M.D., assistant professor of medicine at Johns Hopkins University, in Baltimore. "It turned out they took ginkgo biloba. But if I hadn't asked what they were taking, they would have gone through a total workup with a lot of expensive and unnecessary tests."

One in five adults taking medication report they also use at least one herbal product, a high-dose vitamin, or both. Problem is, many herbs and supplements interact with over-the-counter and prescription medication with the potential for catastrophe. Echinacea and zinc can curb the effect of medications that suppress the immune system, such as corticosteroids or cyclosporine. St. John's wort, the botanical popularly used for anxiety and mild depression, interacts with more drugs than any other supplement. It speeds up the metabolism of medications used to treat heart disease, cancer and HIV, so the patient doesn't receive the full effect of the drugs. It may increase sensitivity to the sun and should be avoided when taking other drugs that do the same, such as sulfa drugs and certain anti-inflammatories. Ironically, St. John's wort can also interfere with the effectiveness of antidepressants.

A new study in JAMA reports that taking some herbs can also raise the risk of complications during surgery. Researchers at the University of Chicago found that 54 percent of surgical patients used herbal medications; some, like ginkgo biloba, raised the risk of bleeding. In addition, the American Society of Anesthesiologists cautions patients against taking herbal remedies for two weeks prior to any surgery because herbs such as ginseng may trigger changes in blood pressure and irregular heartbeat during surgery, and those such as ginkgo biloba may interfere with blood clotting.

Safety strategy: Make a written list of everything you take, including vitamins, and how much you take and how often you take it, and share it with your doctor. If you have had a serious illness such as cancer or have a chronic condition or regularly take medication of any sort (including aspirin), consult with your doctor before trying any supplement.

Health Alert: Herbals and Pregnancy

Products that are ordinarily safe could have devastating effects on women who are pregnant, breast-feeding or trying to conceive. Many vitamins and minerals, such as vitamin A, have lower Upper Intake Levels for pregnant women than for other adults, and have been linked to increased risk of birth defects. Many botanicals are also risky. Centuries ago a tea of tansy and pennyroyal was given to unwed pregnant women in an effort to induce an abortion. Today, these ingredients can be found in preparations marked specifically for pregnant women. To safeguard pregnancy, avoid supplements including safflower, blue cohosh, black cohosh, saffron, rosemary, sassafras, yarrow, tansy, comfrey, pennyroyal, feverfew, garlic, ginger, dong quai, ephedra, echinacea, willow bark and fenugreek. For a complete list, check with your doctor or pharmacist.

For More Information

Contact the Following Groups:

  • The U.S. Food and Drug Administration (FDA): 888-463-6332; www.fda.gov
  • The National Center for Complementary and Alternative Medicine at the National Institutes of Health, 888-644-6226; www.nccam.nih.gov
  • TNP.com (The Natural Pharmacist) reports on scientific studies on herbs, vitamins and supplements.
  • ConsumerLab.com is a lab that tests products and posts results on this site. Some information is free; a year's subscription to the entire site costs $15.95.
  • Quackwatch.com. This site exposes health scams and dubious treatments, and investigates questionable claims.

Reliable Reference Publications:

  • Tyler's Honest Herbal: A Sensible Guide to the Use of Herbs and Related Remedies, by Steven Foster and Varro E. Tyler, Ph.D., $25
  • The Natural Pharmacist: Natural Health Bible, by Steven Bratman, M.D., with David Kroll, Ph.D., $20
  • To order books, call 800-763-6393.

Amy Zintl wrote "The Disease No One Talks About" for the June issue of Ladies' Home Journal.