The Dark Side of Supplements
You’ve seen the glitzy ads in men’s and women’s health magazines, newspapers, direct mail and TV infomercials. Use this or that supplement, or often a combination of several supplements, and you’ll be stronger, sexier, more virile, more beautiful, thinner and live longer. The ingredients are often touted as “all natural” or derived from some exotic plant from the Orient or the jungles of South America. It’s become Big Business! The supplement industry has literally exploded in recent years into a $32 billion/year “industry,” and it’s growing annually as more and more consumers pursue eternal youth – even for their pets! Celebrities and/or professionals are often hired to tout their benefits. If you take the right combination(s), you’ll be smarter, more alert, “burn fat” without dieting and your appearance will transform into that of a much younger and more active man or woman. Half of Americans take supplements and most use more than one at a time.
Well, if a claim sounds just too good to be true, it probably is. There’s a dark side to supplement use that is becoming much more of a clinical problem. Unlike prescription drugs, the supplement industry is largely unregulated by the FDA, which can only step in when a product has been clearly demonstrated to be harmful. And when they do step in, the results can be alarming. Often the labels bear little relation to the supplement’s actual contents. Dr. H. Bonkovsky, Director of Liver & Metabolic Disorder Lab of the Carolinas Healthcare System, has stated that, “It’s anybody’s guess,” as to the actual contents. Inclusion of unlisted steroids is common and some supplements contain up to 30 different ingredients, many of which are not even listed on the packaging.
The NIH’s Drug Induced Liver Injury Network has established that severe liver injury by supplements has tripled over the past decade, now representing >20% of all medication induced hepatitis. It’s even earned a new disease name: NASH – non-alcoholic steato-hepatitis. And the kidneys can be affected too. NASH has resulted in numerous liver and/or kidney transplants, drastically altering life expectancy for the worse. Often it’s difficult to pinpoint the offending supplement, but one in particular has shown up frequently in NASH patients – green tea extract. This extract can contain high concentration of catechins – an antioxidant promoted for energy and weight loss – in amounts far exceed that in a single cup of green tea! High doses of catechins have been demonstrated to be toxic to the liver.
The Prescription Perspective: Since many NASH patients have turned to supplements as an easy weight reduction solution, we are seeing an increasing number of these patients in our weight loss clinics. The typical patients are younger men who use supplements to promote body building or middle aged women who use them for a quick weight loss solution and an energy booster. Initial blood tests often reveal significant abnormalities in liver and kidney chemistries and these patients, who are not candidates for our weight loss program, are quickly referred to liver or kidney specialists for long term care. Sadly, many refuse to abandon the offending supplements.
Just because a product is “natural,” doesn’t mean it’s safe, or even good for you. Don’t forget, arsenic is a “natural” compound too but few would consider it a safe dietary addition. The FDA has estimated that 70% of dietary supplement companies are not following basic quality control procedures to insure safety of their products. The NIH task force has only been able to study about 170 (0.3%) of the 55,000 dietary supplements currently marketed in the US. Many of these contain ingredients from the Orient or eastern Europe and at least one-third included one or more steroids that were not listed on the labels. Furthermore, when one considers that these supplements may contain as many as 30 separate ingredients, the problem becomes truly alarming. While any one of these ingredients may be harmless when taken alone, there is not a scientist in the world who can accurately predict the impact of mixing this many “drugs” in the human body.
Of course, not all supplement companies engage in such questionable practices. The problem for consumers is in distinguishing the good from the bad. Certainly a celebrity endorsement is no guarantee of quality, nor is the recommendation of a friend or trainer. While some supplements, like vitamins, minerals, probiotics and Omega 3 fatty acids, have not been linked to adverse kidney or liver reactions, our best advice to patients mirrors that of Star Wars hero, Luke Skywalker, “Don’t ever go to the Dark Side!” Short cuts to weight loss and body building can end up being a very long trip to serious medical problems. A well designed clinical weight management or workout program administered under medical supervision is often the quickest and most effective way to achieve your goal and remain healthy.