Nutritional Supplements

The next issue of The Medical Letter (June 24, 2013) will include an article on nutritional supplements for age-related macular degeneration, which reminds me of all the articles we have published over the years on the subject of dietary supplements. This goes back to 1994, when the US Congress passed the Dietary Supplement Health and Education Act, a libertarian piece of legislation outspokenly intended to prevent any government agency, and especially the FDA, from interfering with the production and marketing of vitamins, minerals, herbs, etc. Health claims could be made on the labels of these products, so long as they also included a (clearly hypocritical) disclaimer saying that the product is not intended to diagnose, treat, cure or prevent any disease.

Whenever I pass the well-stocked shelves containing these products in my local CVS or Costco, I wonder about the reasons for the public’s fondness for “natural” products and its disregard for the absence of proof of their efficacy or safety. Is it a failure of medicine? Of education? Of religion?

In 2009 we published an article in The Medical Letter about red yeast rice, a food product used in Chinese cooking that became popular in the US as a natural way of lowering cholesterol. It actually does lower cholesterol because it contains naturally occurring HMG-CoA reductase inhibitors, including lovastatin, which was the first statin marketed in the US. Not long after that, a highly intelligent, highly educated friend of mine told me that his doctor, a highly regarded internist, had told him that his cholesterol was a little higher than it should be, but since it was only a little, instead of taking a statin he could just take some red yeast rice capsules. My friend asked me what I thought of that. I told him that actually he was taking a statin, but neither he nor his doctor knew what the dose was. I asked him if he thought that was a good idea. He didn’t answer.

The dietary supplement that I thought would bring people to their senses was a Chinese herb supposed to cause weight loss that actually caused fibrosing interstitial nephritis in about 100 women in Belgium. At least 70 of them required dialysis or a kidney transplant, and 18 subsequently developed urothelial cancer. The nephrotoxin was identified as aristolochic acid, which has been detected in products sold in the US. As far as I can tell from the well-stocked shelves, that hasn’t scared anyone. But it should.

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  1. Nardin S Gottfried, PharmD says:

    Nutritional supplements are a multibillion dollar business that has ownership and investment connections in the US Senate, probably as well as in the House, and in their lobbies. I think a large segment of the population has no concept of what the FDA is, and many of those who think they do, probably have contempt for FDA and are only too glad to thumb their noses at any governmental agency. Thus the outrageous claims get more outrageous and the added or accompanying pollutants and toxins endanger more and more consumers who have purchased the ultimate snake oil ingested in the false and ironic hope of increased wellness. Another sad example of only-the-bottom-line philosophy in the health care arena.

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