Ask the Doc: What's with supplements?
Dear Doctor Littleton: Do you believe supplements really help any? My wife has me on fish oil, vitamin C, red yeast rice, flaxseed oil, St. John's Wort, ginseng (she says the Korean is the best), acetyl L-Carnitine, coenzyme Q-10, vitamin D, magnesium, psyllium husk, probiotics, glucosamine, reservatrol, and saw palmetto. It takes me thirty minutes in the morning to take all these things because I'm tired of arguing with her about it.
Sounds like she loves you and wants you to live well.
However, if she read a recent study, she might be trying to kill you. You might ought to ask her.
The alternative medicine industry is enormous, estimated at $5 billion a year. I would guess that at least 50 percent of my patients are on some supplement of some type. Either by their choice or their spouse's.
Two important questions have to be answered, though: Does it work, and how pure is it?
I believe there are probably more answers to the conditions that ail us in the plant and herbal world than we even know. Ancient texts from Assyria mention the medicinal qualities of the leaves and bark of the willow tree. We now know that molecule is the precursor of aspirin.
Sitting on my desk as I write is a hot beverage extracted from beans (coffee, not lima). Standing outside this building are some folks setting fire to a plant and inhaling it. A commonly used cream for arthritis is from a hot pepper (capsaicin) and causes real trouble for folks who confuse it with their hemorrhoid cream.
A report in BMC Medicine and cited in The New York Times last month, however, casts a long shadow over the actual product in the bottle purchased on the shelf.
Canadian researchers tested 44 bottles from 12 companies of popular supplements purchased over the counter. They tested the components using DNA barcoding, a sort of fingerprinting for plants that detects the unique presence of a plant in a mixture. Think of it as a facial recognition for plants.
One-third of the supplements tested showed complete substitution of the intended product with another product.
The most common replacement products were ingredients from other plants not listed such as soybean, rice, and wheat. In bottles of echinacea, a product many use for treating colds, the bitter weed, Parthenium hysterophorous, noted as invasive plant in Australia and India, was also present in high enough concentration to cause rashes, nausea and flatulence (a troubling side effect when sneezing and coughing).
Most troubling was the presence of some nut products not listed on the label. This could be a real issue for those with nut allergies, even potentially fatal in an extreme case.
The standard for purity and quality are much higher for prescription medicine companies, even to the point of creating shortages due to the tight regulations on production of generic prescription medicines. The F.D.A. is the agency responsible for regulating the supplement industry and does audit a small number of companies every year. The supplement industry attempted to dispute the findings, but even admitted there are some quality control issues in the their industry.
Essentially, prescription drugs are known to be safe (pure product) before selling. Supplements are considered safe (pure) until proven otherwise.
The point is that there are likely many benefits to vitamins and herbs that we have not even discovered. Hopefully, solid research will confirm many of these. My guess is the Chinese, who have been using natural products for over 2,000 years, have more insight into this than traditional western medicine.
But, if you don't feel right, or you stomach is feeling strange, or you are just not sure where that rash is coming from, consider looking at everything going in your mouth from prescription medicines, to supplements, and to your diet. As always, discuss it with your physician and do your research on the companies you are trusting.
Eric J. Littleton, M.D. is a Family Physician in Sevierville, TN. He will be relocating to his new office at 958 Dolly Parton Parkway in January 2014. Topics covered are general in nature and should not be used to change medical treatments and/or plans without first discussing with your physician. Send questions to firstname.lastname@example.org.