Dietary Supplements Warnings

In 1996, consumers spent more than $6.5 billion on dietary supplements. What are dietary supplements? Are they safe? Does the Food and Drug Administration (FDA) approve them?

The 1994 Dietary Supplement Health and Education Act (DSHEA) define dietary supplements as any product that is consumed in addition to a person’s regular diet. This includes vitamins, minerals, herbs, botanicals, or amino acids. Dietary supplements are not drugs. Drugs must undergo clinical studies to determine their effectiveness and safety. The FDA does not currently authorize or test dietary supplements. Manufacturers must only give supportive information to the FDA indicating that a supplement does not present a significant risk of illness or injury under conditions of use recommended in the product’s labeling. Once marketed, the FDA has to prove the dietary supplement is unsafe to remove it from the market.

Manufacturers can make a benefits claim. For example: “Calcium builds strong bones” or “Fiber maintains bowel regularity.” Although there must be proof that the supplement does what is claimed, the manufacturer does not have to share this information with the FDA or the public. These claims must include the following, “This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.”

Beginning in March 1999, the following information is now required on all dietary supplements labels:

Name of product (e.g. St. John’s Wort,ginseng,etc.)
Amount (e.g. “100 capsules”)
Claim/disclaimer
Directions for use (e.g., “Take one capsule with each meal”)
Serving size, amount, and active ingredient
Other ingredients
Name and address of business to write for more product information.
Before using a dietary supplement, check with your doctor or a registered dietitian. It is especially important for people, who are chronically ill, elderly, or taking prescription or over-the-counter medications. Some supplements can interact with medications and cause adverse reactions.

Herbs In The News

Herbal supplements constitute a $1.5 billion business in the United States each year. People are using herbs in place of medicine – but herbs act as medicine. Here is a run down on some of the more popular herbs being used.

St. John’s Wart - is also known as Hardhay, Amber, Goatweed, Klamath Weed and Tipton Weed is used for anxiety, depression, wounds and burns. The suggested dose is 2 to 4 grams daily. There is no known health hazard but may cause sensitivity to light and may inhibit iron absorption. Do not use is taking MAOI inhibitors such as Parnate or certain serotonin reuptake inhibitors such as Prozac or Zoloft. If no improvement in 4 to 6 weeks, discontinue use. Note: St. John’s Wort is currently undergoing a clinical study at the National Institute of Mental Health.

Gingko Biloba - which is also known as Maidenhair-Tree claims to improve memory and assist with tinnitus and vertigo and the suggested dose is 120 mg, 2 to 3 times daily. Do not use if you are taking non-steroidal anti-inflammatory drugs such as aspirin, Vitamin E, or anticoagulants such as warfarin or heparin as it may cause excessive bleeding to occur. Do not use when taking anticonvulsant drugs used by epileptics or tricyclic antidepressants such as Elavil.

Echinacea - which is also known as Black Sampson, Sampson Root and Redbeckia claims to be an immune booster and the suggested dose is 900 mg daily. People with lupus, multiple sclerosis, AIDS, or tuberculosis should not take this herb as it may worsen their condition. Do not take longer than 8 weeks.

Kava kava - which is also known as Ava, Ava Pepper, Intoxicating Pepper and Kawa, claims to be a sedative and help with anti-anxiety and the suggested dose is 60-120 mg daily. Increases the effect of sedatives and could cause over-sedation. Do not take with alcohol. Do not use if you are taking the tranquilizer alprazolam. Discontinue use after 3 months unless you are under a doctor’s supervision.

Remember, herbal supplements are not regulated by the FDA. You do not know what other substances may be in the supplement you are taking or how much of the actual herb is in the bottle.

Supplements to avoid before surgery include the following:

Garlic, ginseng, and ginkgo – All three inhibit blood clotting and increase the risk for bleeding before and after surgery especially when used with blood thinning medications like aspirin or warfarin. Ginseng may also lower blood sugar.

Ephedra – Raises the risk for heart attack and stroke; may cause irregular heartbeat or problems with blood circulation during surgery.

Valerian – May increase the sedative effects of anesthesia. Valerian, if used long-term, may increase the amount of anesthesia needed during surgery.

St. John’s Wort – Dilutes the effects of many drugs needed before, during and after surgery, notably alfentanil, midazolam, protease inhibitors, and warfarin.

Always let your surgical team know what dietary supplements you are taking. The American Society of Anesthesiologists suggests that anyone taking herbs should discontinue them at least two weeks before surgery.