Are supplements dangerous?

I’m all for a newsworthy story on television. But on July 30, 2016 when CBS News invited Dr. Tara Narula to join CBS This Morning: Saturday to discuss “dangerous ingredients that are found in dietary supplements sold around the country” they caught my attention… and nearly lost credibility in my mind. 1

Dr. Tara Narula correctly stated that patients think that “if it’s natural, it’s safe.” But here’s where it derailed: “… but there are real risks associated with the use of these products…with a lack of proven effectiveness for most of them. Many of these products land patients in the Emergency Room, up to 28,000 visits a year from supplements. Patients can have serious organ damage and even have deaths resulting from this. And the problem is because of the lax regulation you have no idea if your product is contaminated with bacteria, heavy metals; if it’s mislabeled; if there are other ingredients in there — other prescription drugs or illegal drugs — and how those supplements are going to interact with your own prescription medications.”

I’d like to challenge her statements and give clarity to the safety of supplements, and the need to find quality manufacturers for the ones you purchase. Because my experience, and the experiences of countless others including my patients, is vastly different.

The 28,000 ER visits per year? “Dangerous” supplements?

Right off the bat, Dr. Narula got my attention when she misquoted a verifiable statistic…

According to an October 2015 report 2 in the New England Journal of Medicine, supplements cause an estimated 23,000 ER visits per year.

The fact that she inflated that number by 5,000 isn’t the really big deal here. The big deal is the bigger picture — and that she failed to put any of this into perspective…

For example, how does this claim compare to the alternative to supplements: prescription drugs. And more importantly, which supplements was she even referring to? I had to look further into her claims… 

So, for starters, I googled to find the information she was quoting from. Along with it, the search yielded some eye-opening results: On the very same Google search page this headline appeared…

“Drug-Related Poisoning: The Cause For Nearly 700,000 Emergency Department Visits a Year, According to New Research.”

That was reported in 2011 by the American College of Emergency Physicians. 3

We know that more than half 4 of the approximately 247 Million adults 5 in the United States use supplements. And we know that the same statistic holds true for prescription drug use…nearly half of us use at least one prescription medication 6 according to the Centers for Disease Control.

If you do the math (700,000 divided by 23,000), that makes prescription medications 30 times more likely to land you in the ER than a supplement.

That’s something to think about.

But what about those “dangerous ingredients” found in supplements?

This is where it gets really revealing…

More than half of the ER visits that had anything to do with supplements were due to weight loss or energy supplements ingested by patients aged 5 (unsupervised children) to 19 years old. And weight loss supplements were to blame among patients 20 to 34.

This isn’t surprising, since weight loss supplements (and the unadvisable trend towards fast energy) most commonly cause symptoms of a racing heart (palpitations) — and that scares people sometimes resulting in panic and chest pains.

The next most common category causing cardiac symptoms were from bodybuilding and sexual-enhancement supplements. But when it came to ER visits from taking micronutrients (vitamins and minerals) — those were related to allergic reactions…or trouble with swallowing the pills. And of course allergic reactions to prescription meds are quite common as well.

So, if you consider there are always going to be some people with allergies… and some people who may not be cautious with their weight loss or muscle or sexual enhancement strategies — there will be those that end up in the ER.

But here’s the kicker: Less than 1 in 10 of those visits resulted in hospitalization… 2,154 people yearly on average… out of more than 150 Million who take supplements.

Possible product contamination with other ingredients

Now let’s look at her statement that, “…because of the lax regulation you have no idea if your product is contaminated with bacteria, heavy metals; if it’s mislabeled; if there are other ingredients in there — other prescription drugs or illegal drugs — and how those supplements are going to interact with your own prescription medications.”

There are different quality levels of supplement manufacturing for sure. For example, the company I purchase my supplements from complies with the current Good Manufacturing Practices (GMPs).

This means that raw materials as well as finished products go through close examination and testing using well-defined criteria for appearance, identity, potency, microbial purity, and any potential contaminants. Their products are tested again when they get mixed; and then again as finished products. I personally have taken a tour through this company’s manufacturing facility — wearing a hair cover, face mask, gown, and shoe covers — and was very impressed by the quality control process they use.

Furthermore, the company that manufactures the supplements I use knows who their suppliers of raw materials are, and they put them through a qualification and approval process too. Plus, they have NSF (National Sanitation Foundation) 7 8 conduct independent, third-party testing and certification 9 at their site (which is above GMP specifications).

Where Dr. Tara Narula is correct is that there are some manufacturers that have no stringent quality control. An example is the 2013 NYC State Attorney General’s office investigation, 10 in which they bought 78 bottles of leading supplement brands from Wal-Mart, Target, GNC, and Walgreens sold in New York and had them analyzed…

They used DNA bar coding to detect ingredients, a genetic fingerprinting technology used to root out labeling fraud by seafood manufacturers — and they found that four out of five of the products did not contain any of the herbs in their bottles that were shown on their labels.

That sounds a bit dramatic, but if we are to believe it, their testing needs to be corroborated to be sure this is not just a slam to the supplement industry. I welcome it. That’s because they would never find that kind of mislabeling at the quality companies I know.

As to safety of supplements, I also found an online article, “15 Supplement Ingredients to Always Avoid,” because they “can cause organ damage, cardiac arrest, and cancer.”

Their list included green tea extract powder, Kava, and red yeast rice — supplements I’ve recommended for years. So, I’d like to share more about this — and the effectiveness of supplements — in my next article. Till then…

To feeling good, and healthy,

Michael Cutler, M.D.
Easy Health Options

[1] http://www.cbsnews.com/videos/topics/cbs-this-morning/
[2] http://www.nejm.org/doi/full/10.1056/NEJMsa1504267#t=article
[3] http://newsroom.acep.org/2011-03-16-Drug-Related-Poisoning-The-Cause-For-Nearly-700-000-Emergency-Department-Visits-a-Year-According-to-New-Research
[4] Radimer K, Bindewald B, Hughes J, Ervin B, Swanson C, Picciano MF. Dietary supplement use by US adults: data from the National Health and Nutrition Examination Survey, 1999-2000. Am J Epidemiol. 2004 Aug 15;160(4):339-49. http://www.ncbi.nlm.nih.gov/pubmed/15286019
[5] http://datacenter.kidscount.org/data/tables/99-total-population-by-child-and-adult#detailed/1/any/false/573,869,36,868,867/39,40,41/416,417
[6] http://www.cdc.gov/nchs/fastats/drug-use-therapeutic.htm
[7] Manufacturers, regulators and consumers look to NSF International for the development of public health standards and certification programs that help protect the world’s food, water, consumer products and environment.
[8] http://www.nsf.org/about-nsf/
[9] http://www.nsf.org/consumer-resources/what-is-nsf-certification/dietary-sports-supplements-certification
[10]http://well.blogs.nytimes.com/2015/02/03/new-york-attorney-general-targets-supplements-at-major-retailers/?_r=0

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Dr. Michael Cutler

By Dr. Michael Cutler

Dr. Michael Cutler is a graduate of Tulane University School of Medicine and is a board-certified family physician with more than 20 years of experience. He serves as a medical liaison to alternative and traditional practicing physicians. His practice focuses on an integrative solution to health problems. Dr. Cutler is a sought-after speaker and lecturer on experiencing optimum health through natural medicines and founder of the original Easy Health Options™ newsletter — an advisory on natural healing therapies and nutrients. His current practice is San Diego Integrative Medicine, near San Diego, California.